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| Effect of lamivudine on viral control in patients with chronic hepatitis B acute liver failure |
| Zhao Qijie1, Ye Weizhen1, Li Weiping2 |
1 Infection Department, Ninghai First hospital of Zhejiang Province, Ninghai 315600, China;
2 Infection Department, Huzhou Central Hospital |
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Abstract Objective To investigate the effect of lamivudine on viral control in patients with chronic hepatitis B acute liver failure. Methods Eight patients with acute hepatitis B liver failure admitted to our hospital from January 2015 to November 2016 were randomly divided into two groups. The control group were treated with conventional treatment measures, while the observation group was treated with the use of lamivudine treatment besides conventional treatment measures. The changes of virological indicators total bilirubin (TBil), serum alanine aminotransferase (ALT), prothrombin activity (PTA) and albumin (Alb) of the two groups were analyzed and detected, and the negative rate after treatment of the two groups were compared. The end-stage liver disease model (MELD) was used to assess the disease improvement after treatment. Results The changes of virological indicators of patients of two groups were obvious before and after the treatment. The levels of ALT and TBil reduced, and levels of PTA and Alb increased. TBil and ALT levels of the observation group after treatment were (188.2±67.5) and mmol/L (92.4± 34.1) U/L, PTA and Alb levels were (50.7±4.9)% and (37.1±4) g/L. The decreases and increases of the observation group were more significant than those in the control group, and the difference was statistically significant (P<0.05). (HBV) quantitative DNA of both groups of patients significantly decreased before and after the treatment. (HBV) quantitative DNA of the observation group was (3.2±0.1) copies/mL after the treatment, while that of the control group was (4±0.2) copies/mL. (HBV) quantitative DNA of the observation group was significantly lower than that of the control group, and there was statistical significance (P<0.05). After treatment, the observation group had 28 cases (70%) (HBV) DNA negative, 14 cases in the control group (35%) with (HBV) DNA negative, and there was statistical significance (P<0.05). After treatment, 27 cases (67.5%) in the observation group improved, and 5 cases died (12.5%). While 16 (40%) cases in the control group improved, and 18 cases died (45%). the mortality of the observation group was lower than that of the control group, and the difference was statistically significant (P<0.05). After treatment, the Child-Pugh score of the observation group was (6.9 ± 1.6) points, significantly lower than that (9.7 ± 1.8), in the control group, with statistical significance (P<0.05). Conclusion The use of lamivudine in the treatment of patients with acute on chronic hepatitis B liver failure, can significantly improve the liver function and virological indicators, promote liver metabolism, improve prognosis effectively, have good clinical effect, reduce the mortality of patients, and improve the clinical efficacy, so it is worthy of promotion.
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Received: 27 September 2017
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[1] 赵文革,马艳丽.恩替卡韦和拉米夫定治疗乙型慢加急性肝衰竭3年疗效的对比研究[J].中国医药,2012,7(2):169-171.
[2] 宁更献,李力,侯军良,等. 慢加急性肝衰竭病因、临床特点与预后关系分析[J].河北医药,2017,39(2):214-216.
[3] 鱼康康,李宁,施光峰. 在争议中迈步向前:慢加急性肝衰竭研究进展[J].肝脏,2014,19(3):208-210.
[4] 彭伟彬,刘颜,伍友春,等.2003—2016年某院住院死亡病例疾病谱统计分析[J].中国医院统计,2017,24(4):241-244.
[5] GAO S, JOSHI SS, OSIOWY C, et al. Chronic hepatitis B carriers with acute on chronic liver failure show increased HBV surface gene mutations, including immune escape variants[J]. Virol J. 2017;14(1):203.
[6] JOCHUM C, MAISCHACK F, ANASTASIOU OE, et al. Treatment of fulminant acute Hepatitis B with nucles(t)id analogues is safe and does not lead to secondary chronification of Hepatitis B[J]. Z Gastroenterol. 2016,54(12):1306-1311.
[7] 尹胜平,郭堑,蒋茵,等.拉米夫定治疗慢性乙型肝炎引起的慢加急性肝衰竭患者的临床研究[J].中国医药导报,2012,9(17):182-183.
[8] 邱德山,徐东,王怡,等.高密市2014年人群乙肝血清学调查结果分析[J].中国医院统计,2017,24(2):88-91.
[9] 张建春.拉米夫定和阿德福韦脂初始联合与恩替卡韦单药治疗高病毒载量慢性乙型肝炎疗效观察[J].中华临床感染病杂志,2012,5(3):142-144.
[10]TILLMANN HL, HADEM J, LEIFELD L, et al. Safety and efficacy of lamivudine in patients with severe acute or fulminant hepatitis B a multicenter experience[J]. Journal of viral hepatitis,2012,4(4):188-192.
[11]SHALIMAR, SARASWAT V, SINGH SP, et al. Acute-on-chronic liver failure in India: The Indian National Association for Study of the Liver consortium experience[J]. J Gastroenterol Hepatol, 2016,31(10):1742-1749.
[12]CHANG TT, GISH RG, DE MR, et al. A comparison of entecavir and lamivudine for HBeAg-positive chronic hepatitis B[J]. The New England journal of medicine,2013,10(10): 881-891.
[13]周祖模,陈林,金志刚,等.拉米夫定应答不佳慢性乙型肝炎患者加用阿德福韦酯与换用恩替卡韦疗效比较[J].中华临床感染病杂志, 2012,5(6):328-331.
[14]丁艾昆,郭利伟,董格峰.拉米夫定与恩替卡韦治疗乙肝病毒相关的慢加急性肝衰竭近期疗效比较[J].山东医药,2015,55(18):77-78.
[15]李晨,游绍莉,刘鸿凌,等.老年HBV相关慢加急性肝衰竭患者临床特点及其近期预后危险因素的研究[J].中华保健医学杂志,2015,17(2):108-112.
[16]司慧远,靳雁斌,李晓娟,等.抗病毒治疗乙型肝炎相关慢加急性肝衰竭患者的临床研究[J].现代生物医学进展,2014,14(33):6464-6466.
[17]郭利伟,丁艾昆,刘伟,等.253例乙型肝炎病毒引起的慢加急性肝衰竭预后影响因素分析[J].中国病原生物学杂志,2014,9(3):275-278.
[18]杨敏.拉米夫定与恩替卡韦治疗慢性乙肝相关慢加急性肝衰竭疗效比较[J].现代消化及介入诊疗,2016,21(4):569-571.
[19]叶非,过建春,裘云庆,等.恩替卡韦、拉米夫定治疗HBeAg阴性乙型肝炎相关慢加急性肝衰竭12周疗效比较[J].中华实验和临床病毒学杂志,2014,28(3):209-212.
[20]MARION PL, SALAZAR FH, WINTERS MA, et al. Potent efficacy of entecavir (BMS-200475) in a duck model of hepatitis B virus replication[J]. Antimicrobial Agents and Chemotherapy,2012,1(1):103-108.
[21]SELVA RA, LIM SG, PHYO WW,et al. Acute-on-chronic liver failure in a multi-ethnic Asian city: A comparison of patients identified by Asia-Pacific Association for the Study of the Liver and European Association for the Study of the Liver definitions[J]. World J Hepatol, 2017,9(28):1133-1140.
[22]梁桂才,黄献球.拉米夫定与恩替卡韦治疗慢性乙型肝炎慢加急性肝功能衰竭的对比研究[J].成都医学院学报,2016,11(1):58-61.
[23]韦炜,黄智铭.恩替卡韦与拉米夫定联合阿德福韦酯治疗e抗原阳性慢性乙型肝炎的疗效[J].中华医院感染学杂志,2012,22(19):4335-4336.
[24]姚仲彩.拉米夫定联合阿德福韦酯与恩替卡韦治疗慢性乙型肝炎疗效比较[J].国际流行病学传染病学杂志, 2012,37(5):309-311.
[25]黄睿,郝迎迎,张俊,等.拉米夫定联合阿德福韦酯与恩替卡韦单药对慢性乙型肝炎初治患者疗效比较的Meta分析[J].重庆医学, 2014,1(1):9-11.
[26]叶素素.拉米夫定和恩替卡韦分别联合阿德福韦酯治疗阿德福韦酯耐药慢性乙型肝炎效果[J].中国医药, 2015,10(7):993-995.
[27]张淑娥.拉米夫定联合阿德福韦酯与恩替卡韦单药治疗HBeAg阳性慢性乙型肝炎疗效观察[J].实用肝脏病杂志, 2014,1(5):527-528.
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