Effect of nucleoside drugs on clinical features, progression and prognosis of patients with acute on chronic hepatic failure
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摘要:目的 探讨核苷酸类药物对慢加急性肝衰竭患者临床特征、转归及预后的影响。方法 选取慢加急性肝衰竭患者108例，以随机试验原则分为治疗组与对照组各54例。对照组采用常规内科治疗，治疗组在对照组基础上给予口服核苷酸类药物进行治疗。比较2组患者治疗前后外周血细胞指标(白细胞计数、中性粒细胞、血小板、血红蛋白水平)及凝血功能。对患者年龄、是否存在腹水、肝性脑病及基线HBV-DNA、丙氨酸氨基转移酶、天冬氨酸氨基转移酶及终末期肝病模型(MELD)等因素进行Logistic回归分析，探讨预后的影响因素。结果 治疗后, 2组外周血白细胞、中性粒细胞较治疗前显著降低，且治疗组效果显著优于对照组(P < 0.05)。治疗后, 2组血小板、血红蛋白水平较治疗前显著升高，且治疗组显著优于对照组(P < 0.05)。治疗后，治疗组凝血酶原时间、国际标准化比值显著低于对照组，纤维蛋白原含量显著高于对照组(P < 0.05)。腹水、肝性脑病及MELD评分对患者预后生存状况有显著影响。结论 腹水、肝性脑病及MELD评分对患者预后生存状况有显著影响，核苷酸类药物能够有效改善慢加急性肝衰竭患者外周血细胞指标水平及细胞凝血功能。Abstract:Objective To investigate the effect of nucleotide drugs on clinical features, progression and prognosis of patients with acute on chronic hepatic failure.Methods Totally 108 patients with acute on chronic hepatic failure were selected and randomly divided into treatment group and control group, with 54 cases in each group. The control group was treated with routine medical treatment, while the treatment group was treated with nucleotide drugs orally on the basis of the control group. Peripheral blood cell indexes (white blood cell count, neutrophil, platelet, hemoglobin) and coagulation function were compared between the two groups before and after treatment.Logistic regression analysis was applied in age, ascites, hepatic encephalopathy, baseline HBV-DNA, alanine aminotransferase, aspartate aminotransferase and model for end-stage liverdisease (MELD) to explore the influencing factors of prognosis.Results After treatment, peripheral blood leukocytes and neutrophils in both groups were significantly lower than those before treatment, and those in the treatment group was significantly better than the control group (P < 0.05). After treatment, platelet and hemoglobin levels in both groups were significantly higher than those before treatment, and those in the treatment group were significantly better than the control group (P < 0.05).After treatment, the prothrombin time and international standardized ratio in the treatment group were significantly lower than those in the control group, and the fibrinogen content was significantlyhigher than that in the control group (P < 0.05). Ascites, hepatic encephalopathy and MELD score show significant influence on the prognosis and survival of patients.Conclusion Ascites, hepatic encephalopathy and MELD score show significant influence on prognosis and survival of patients.Nucleotide drugs can effectively improve the level of peripheralblood cell indexes and cell coagulation function in patients with acute on chronic hepatic failure.
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表 1 2组患者一般资料比较(x±s)
一般资料 治疗组(n=54) 对照组(n=54) 性别 男 43 41 女 11 13 年龄/岁 40.24±5.47 41.28±4.91 基线HBV-DNA 5.54±1.98 5.39±2.18 血清总胆红素/(μmol/L) 451.24±95.91 474.24±97.29 
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表 2 2组患者治疗前后外周血细胞指标比较(x±s)
×109/L 组别 时点 白细胞计数 中性粒细胞 血小板 血红蛋白 对照组 治疗前 9.01±3.75 7.12±4.91 98.53±26.57 111.45±29.78 治疗后 7.65±4.06* 5.31±2.54* 106.61±21.53* 117.52±29.47* 治疗组 治疗前 9.09±3.89 6.98±4.27 99.58±29.46 110.28±31.59 治疗后 4.56±3.81*# 2.89±0.94*# 125.82±34.28*# 142.53±32.85*# 与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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表 3 2组凝血功能变化比较(x±s)
组别 时点 凝血酶原时间/s 国际标准化比值 纤维蛋白原/(g/L) 对照组 治疗前 27.52±9.24 2.23±0.25 1.31±0.38 治疗后 22.15±3.67* 2.01±0.17* 1.48±0.56* 治疗组 治疗前 26.91±8.37 2.31±0.19 1.28±0.41 治疗后 14.95±4.29*# 1.45±0.32*# 2.10±0.71*# 与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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表 4 患者预后影响因素分析
因素 Score df P 年龄 2.541 1 0.526 腹水 5.267 1 0.021 肝性脑病 4.219 1 0.016 基线HBVDNA 1.648 1 0.634 丙氨酸氨基转移酶 2.139 1 0.589 天冬氨酸氨基转移酶 1.279 1 0.714 MELD评分 6.259 1 0.015 MELD: 终末期肝病模型。
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