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目的探讨患者停用核苷和核苷酸类药物(NAs)抗HBV后诱发慢加急性肝衰竭(ACLF)的临床特征。方法回顾性分析2014年6月-2016年10月南昌大学第一附属医院收治的确诊为ACLF的患者865例,其中因停药诱发ACLF的患者137例(停药组),非停用NAs诱发ACLF的患者728例(非停药组),详细记录患者抗病毒药物种类、规范抗病毒持续时间、停药方式、停药至发生肝衰竭时间、停药后监测情况、肝脏基础疾病、进展为ACLF后30 d病死率等。计量资料组间比较采用t检验;计数资料组间比较采用χ~2检验。结果非停药组728例患者中治愈或好转、死亡或无效分别为389例和339例。137例停药组患者中慢性病毒性肝炎基础69例,其中治愈或好转、死亡或无效分别为40例和29例;肝硬化基础68例,其中治愈或好转、死亡或无效分别为16例和52例,差异有统计学意(χ~2=16.81,P<0.001)。137例停药患者中停药前服用拉米夫定占24.09%(33/137),阿德福韦酯占34.31%(47/137),拉米夫定联合阿德福韦酯占11.68%(16/137),恩替卡韦占27.01%(37/137)。停药组诱发ACLF时的持续时间≤6个月占57.66%(79/137),6~12个月占18.25%(25/137),>12个月占23.36%(32/137)。结论本研究提示NAs不当停药后易诱发ACLF。一旦停药,要在停药的前6个月内密切观察乙型肝炎病毒学、肝功能、肝脏影像学等变化。肝脏基础疾病决定停药后ACLF的发生及预后,长期规范抗病毒治疗对肝硬化患者尤为重要。
Objective To investigate the clinical characteristics of slow-acting acute liver failure (ACLF) induced by anti-HBV inactivation of nucleosides and nucleotides (NAs) in patients. Methods A retrospective analysis of 865 patients diagnosed as ACLF from the First Affiliated Hospital of Nanchang University from June 2014 to October 2016 was conducted. Among them, 137 patients with withdrawal-induced ACLF (withdrawal group) and non-withdrawal of NAs 728 patients with ACLF (non-stop group) recorded in detail the types of patients with antiviral drugs, standardized anti-virus duration, withdrawal methods, withdrawal time to liver failure, monitoring after stopping the drug, liver diseases, progress was ACLF after 30 d fatality rate and so on. Measurement data between groups using t test; count data between the groups using χ ~ 2 test. Results Among 728 non-stop patients, 389 and 339 patients were cured or improved, respectively. Of the 137 patients who discontinued, 69 patients had chronic hepatitis based on chronic hepatitis C, 40 patients were cured or improved, and 29 patients died or ineffective. The basis of cirrhosis was 68 patients, of which 16 patients were cured or improved, and 16 patients died or were ineffective Cases, the difference was statistically significant (χ ~ 2 = 16.81, P <0.001). Of the 137 patients who discontinued lamivudine before treatment, 24.09% (33/137), adefovir dipivoxil (34.31%) (47/137), lamivudine combined with adefovir dipivoxil accounted for 11.68% (16/137), entecavir accounted for 27.01% (37/137). The duration of induction of ACLF in the withdrawal group was 57.66% (79/137) for 6 months, 18.25% (6/137) for 6-12 months and 23.36% (32/137) for> 12 months. Conclusion This study suggests that ACLF can be easily induced after improper NAs withdrawal. Once the withdrawal, in the first six months of withdrawal from close observation of hepatitis B virus, liver function, liver imaging and other changes. Liver diseases determine the incidence and prognosis of ACLF after drug withdrawal, and long-term standard antiviral therapy is particularly important for patients with cirrhosis.