【作者】 高冉冉；

【导师】 张跃新；

【作者基本信息】 新疆医科大学 ， 内科学， 2009， 硕士

【摘要】 目的:回顾性的总结抗病毒治疗对慢性乙型重型肝炎近期预后的影响,以求改善和提高慢性乙型重症肝炎的治疗水平。方法:采用回顾性分析,收集从2000年到2008年就诊于新疆医科大学第一附属医院感染科的84例慢性乙型重型肝炎患者的临床资料,这些患者被分为抗病毒治疗组(44例)和对照组(40例)。抗病毒组在内科常规治疗基础上,加用核苷类药物抗病毒药物;对照组患者仅使用内科常规支持治疗。于治疗后2周、4周观察各项指标,并分析比较抗病毒治疗组与对照组患者生化指标、病毒转阴率、MELD评分、生存率,预期死亡率和实际死亡率等。结果:1)治疗后2周各项观察指标示:①治疗2周后两组的TBiL、PTA、INR均值差异均有显著统计学意义(P<0.05),其他各指标没有统计学差异(P>0.05)。②抗病毒治疗组治疗前后MELD评分差异有统计学意义(P<0.05),对照组治疗前后没有统计学差异(P>0.05)。抗病毒治疗组与对照组治疗后比较,MELD评分差异有统计学意义(△P<0.05)。③抗病毒治疗组MELD评分20～29分组的预期死亡率与实际死亡率,差异有统计学意义(P<0.05),其他评分段预期死亡率和实际死亡率差异没有统计学意义;对照组MELD评分各段预期死亡率与实际死亡率之间均没有统计学差异(P>0.05)。2)抗病毒治疗4周各项观察指标示:①治疗4周后治疗组与对照组相比病毒转阴率差异有显著统计学意义,P<0.05.②初始病毒载量≥105拷贝/ml与<105拷贝/ml组的患者相比生存率差异有统计学意义(P<0.05)③治疗4周后抗病毒组与对照组生存率差异有显著统计学意义(P<0.05)。④合并并发症的患者中两组生存率差异有统计学意义,P<0.05。结论:抗病毒治疗可以改善生化指标,提高病毒转阴率,降低MELD评分,提高生存率,改善慢性乙型重型肝炎的预后。更多还原

【Abstract】 Objective: To explore the influence of short-term prognosis of chronic severe hepatitis B patients treated with nucleosides antiviral therapy. To improve the level of treatment in patients with chronic severe hepatitis B. Method: A retrospective analysis was performed in 84 patients with chronic severe hepatitis B who hospitalized in Department of Infectious Diseases, First Affiliated Hospital, Xinjiang Medical University during period of 2000-2008..A total of 84 patients were divided into antiviral therapy and control groups. 44 patients in antiviral therapy group were treated with nucleosides antiviral drugs besides routine supportive therapy.40 patients in control group were only applied with routine supportive therapy. To observe every index after 2 and 4 weeks, analysis the biochemical indicator, negative conversion rate of HBVDNA, MELD score, virus survival rate, predictive mortality and actuality mortality of two groups. Result: 1.After 2weeks treatment the indexs are as follow:①There are difference between two groups of TBiL? PTA?INR (P<0.05). Another indexs have no differences (P>0.05).②In antiviral therapy group, MELD score has significant difference between before and after treatment (P<0.05). Control group has no significant difference in MELD score between patients before treatment and after treatment (P>0.05) After 2 weeks treatment there were significant difference in MELD score between patients in antiviral therapy group and control group (△P<0.05).③After 2 week treatment, the antivival group which MELD score between 20 to 29, there are significant difference between predictive mortality and actuality mortality (P<0.05). There was no significant difference between predictive mortality and actuality mortality in other MELD score group of antivival group. In every MELD score section of control group, there was no significant difference between predictive mortality and actuality mortality after 2 week treatment. (P>0.05). 2. After 4 weeks treatment the indexs are as follow:①After 4 weeks treatment, there are significant difference in negative conversion rate of HBVDNA between two groups (P<0.05).②There are significant difference in incipient virus load between patients in≥105copies/ml group and<105 copies /ml group (P<0.05).③There are significant difference in the survival rate of patients between antiviral therapy group and control group (P<0.05).④There are significant difference in patients who have complication between antiviral therapy group and control group (P<0.05). Conclusion: Antiviral therapy can improve the biochemical indicator, increase the conversion rate of HBVDNA, depress the MELD score, increase the the survival rate, improve the prognosis of chronic severe hepatitis B.更多还原