实用肝脏病杂志 ›› 2010, Vol. 13 ›› Issue (4): 275-277.doi: 10.3969/j.issn.1672-5069.2010.04.012

• 论著 • 上一篇    下一篇

乙型肝炎肝衰竭生存者的继续治疗与随访*

宋海燕,刘波,张骏飞,陈从新,马勇,周跃进,潘兴南,郑瑞丹 王全楚,汪茂荣,何长伦,傅青春,陈成伟   

  1. 230031 合肥市 安徽医科大学解放军临床学院/解放军第105医院感染病科(宋海燕,刘波,张骏飞,陈从新);
    第123医院肝病中心(马勇);
    第118医院感染病科(周跃进);
    第180医院肝病中心(潘兴南);
    第175医院感染病科(郑瑞丹);
    第153医院感染病科(王全楚);
    第81医院肝病中心(汪茂荣,何长伦);
    第85医院肝病中心(傅青春,陈成伟)
  • 收稿日期:2010-03-12 出版日期:2010-08-10 发布日期:2016-04-18
  • 通讯作者: 陈从新 男,52岁,主任医师,教授,博士生导师。E-mail:congxinc@mail.hf.ah.cn
  • 作者简介:宋海燕 女,28岁,硕士研究生。E-mail:042899shyan@163.com
  • 基金资助:
    南京军区联勤部卫生部第十一五重大攻关课题(07Z007-A);南京军区“122”人才培养基金(122-lA)

Eighteen-month of follow-up of hepatitis B-induced hepatic failure survivals receiving interferon-α,lamivudine and matrine treatment

SONG Haiyan,LIU Bo,ZHANG Junfei. et al.   

  1. Department of Infectious Diseases,105th Hospital,Anhui Medical University,Hefei 230031,China
  • Received:2010-03-12 Online:2010-08-10 Published:2016-04-18

摘要: 目的 随访α-干扰素、拉米夫定和拉米夫定联合苦参碱防治乙型肝炎肝衰竭生存者的中期疗效。方法 在多中心选择亚急性或慢加亚急性乙型肝炎肝衰竭生存者(A组)110例,分别接受α-干扰素、拉米夫定和拉米夫定联合苦参碱治疗6个月;选择慢性乙型肝炎肝衰竭生存者(B组)110例,分别给予拉米夫定和拉米夫定联合苦参碱治疗6个月。随访18个月。结果 在随访18个月时,A组患者全部生存,其中25.6%(10/39)接受α-干扰素治疗的患者,改用拉米夫定治疗,21.1%(15/71)接受拉米夫定或拉米夫定联合苦参碱治疗的患者改用阿德福韦酯治疗;B组接受拉米夫定治疗的患者死亡5例(9.4%),接受拉米夫定联合苦参碱治疗的患者死亡6例(10.5%),18.2%(18/99)生存者改用阿德福韦继续治疗。拉米夫定治疗使超过80%患者血清HBV DNA转阴,α-干扰素或拉米夫定联合苦参碱治疗患者HBeAg阴转和HBeAg/抗-HBe血清学转换率不比单用拉米夫定治疗者高。结论 乙型肝炎肝衰竭生存者长期口服核苷类抗病毒药对阻断肝纤维化的发展有明显的疗效。由于本组α-干扰素和苦参碱的治疗时间相对较短,其中长期疗效还有待进一步探讨。

关键词: 乙型肝炎, 肝衰竭, 拉米夫定, α-干扰素, 苦参碱

Abstract: Objective To observe the effect of interferon-alpha,lamivudine and oxymatrine treatment for hepatitis B-induced hepatic failure survivals. Methods One hundred and ten subacute or acute-on-chronic hepatic failure survivals(group A) received interferon alpha(n=39),lamivudine(n=37),or combination of lamivudine and oxymatrine(n=34)therapy for six months,and one hundred and ten chronic hepatic failure survivals(group B)received lamivudine(n=53),or combination of lamivudine and oxymatrine(n=57)therapy for six months,respectively. All patients were followed-up for eighteen months. Results At the end of follow-up,all patients in group A survived and 25.6%(10/39)of survivals with interferon alpha treatment switched to lamivudine therapy,and 21.1%(15/71)with lamivudine or lamivudine and oxymatrine to adefovir dipivoxil therapy,while in group B five patients (9.4%)receiving lamivudine,and six(10.5%)patients receiving combinational therapy died and 18.2%(18/99)of survivals switched to adefovir therapy;80% of survivals with lamivudine treatment in both groups had their serum HBV DNA loss and the HbeAg negativity and/or HBeAg/anti-Hbe seroconversion rates in patients with interferon alpha or lamivudine and oxymatrine treatment were not higher than those in survivals with lamivudine alone. Conclusion Long term administration of nucleos(t)ides analogues might block the progress of hepatic fibrosis in hepatitis B-induced liver failure survivals,however,the effects of interferon alpha or matrine treatment in this settings maybe due to relatively short-term administration needs to be further investigated.

Key words: Hepatitis B, Liver failure, Lamivudine, Interferon alpha, Matrine