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目的探讨长期抗病毒治疗对乙型肝炎肝硬化患者的预后及转归影响。方法收集新疆医科大学第一附属医院感染科2007年至2011年期间238例乙型肝炎肝硬化患者临床资料,建立数据库,并行回顾性分析。治疗组(抗病毒组)160例,对照组(未抗病毒组)78例。治疗组使用拉米夫定、阿德福韦酯、替比夫定、恩替卡韦单药或联合抗病毒治疗,疗程3年~7年,平均疗程50个月。所有肝硬化患者均行保肝、抗纤维化、纠正肝功能等内科综合治疗。评价指标:抗病毒治疗能否改善肝功能(Child-Turcotte-Pugh,CTP评分)、减少肝硬化病死率、提高生存率;抗病毒治疗能否减少肝癌发生率。两组生存曲线比较采用Log-rank检验(检验标准α=0.05);预后采用Kaplan Meier法(Log-rank检验)进行单因素分析。结果治疗组中位生存时间为38.7个月,12、24、50个月生存率为74.4%、64.4%、41.9%;对照组中位生存时间为30.9个月,12、24、50个月生存率为67.9%、53.8%、39.7%,差异有统计学意义(χ2=9.350,P<0.05)。治疗组患者行50个月的治疗观察,预后分析结果提示HBV DNA、ALT、PTA、CTP评分、是否抗病毒治疗影响肝硬化患者预后比较差异有统计学意义(P<0.05)。治疗组与对照组患者12、24、50个月累计病死率分别为25.6%、35.6%、58.1%及32.1%、46.2%、60.3%,差异有统计学意义(P<0.05);累计肝癌发生率分别为6.4%、12.5%、23.1%及10.3%、16.7%、26.8%,差异有统计学意义(P<0.05)。结论乙型肝炎肝硬化患者短期抗病毒治疗受益可能不大,长期规范化抗病毒治疗可降低肝硬化患者病死率,降低肝癌发生率。
Objective To investigate the effect of long-term antiviral therapy on the prognosis and prognosis of patients with hepatitis B cirrhosis. Methods The clinical data of 238 patients with hepatitis B cirrhosis from 2007 to 2011 in Department of Infectious Diseases, the First Affiliated Hospital of Xinjiang Medical University were collected and a database was established. The data were retrospectively analyzed. Treatment group (anti-virus group) 160 cases, control group (no anti-virus group) 78 cases. Treatment group lamivudine, adefovir dipivoxil, telbivudine, entecavir monotherapy or combined antiviral therapy, treatment of 3 years to 7 years, the average course of 50 months. All liver cirrhosis patients underwent liver protection, anti-fibrosis, liver function and other medical comprehensive treatment. Evaluation index: whether antiviral therapy can improve liver function (Child-Turcotte-Pugh, CTP score), reduce the mortality of cirrhosis, improve survival; anti-virus treatment can reduce the incidence of liver cancer. The survival curves of two groups were compared by Log-rank test (test standard α = 0.05); prognosis by Kaplan Meier method (Log-rank test) for univariate analysis. Results The median survival time was 38.7 months in the treatment group and 74.4%, 64.4% and 41.9% in the 12, 24 and 50 months respectively. The median survival time in the control group was 30.9 months and the survival rates in 12, 24 and 50 months The rates were 67.9%, 53.8% and 39.7%, respectively, with significant difference (χ2 = 9.350, P <0.05). The patients in the treatment group were treated for 50 months. The results of prognostic analysis indicated that there was a significant difference in the prognosis of patients with cirrhosis after HBV DNA, ALT, PTA, CTP scores (P <0.05). The cumulative death rates of patients in treatment group and control group at 12, 24 and 50 months were 25.6%, 35.6%, 58.1% and 32.1%, 46.2% and 60.3% respectively, with significant difference (P <0.05) Rates were 6.4%, 12.5%, 23.1% and 10.3%, 16.7% and 26.8%, respectively, with significant differences (P <0.05). Conclusion The short-term antiviral treatment of patients with hepatitis B cirrhosis may not benefit greatly. Long-term standardized antiviral treatment can reduce the mortality of patients with cirrhosis and reduce the incidence of liver cancer.