[1]袁婧,张长江,朱研,等.核苷(酸)类似物治疗乙型肝炎病毒相关肝病患者停药复发的临床转归及影响因素[J].陆军军医大学学报(原第三军医大学学报),2014,36(08):811-815.
 Yuan Jing,Zhang Changjiang,Zhu Yan,et al.Clinical outcome and impact factors of HBV-related patients’ relapse after nucleoside/nucleotide analogues withdrawal[J].J Amry Med Univ (J Third Mil Med Univ),2014,36(08):811-815.
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核苷(酸)类似物治疗乙型肝炎病毒相关肝病患者停药复发的临床转归及影响因素(/HTML )
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陆军军医大学学报(原第三军医大学学报)[ISSN:1000-5404/CN:51-1095/R]

卷:
36卷
期数:
2014年第08期
页码:
811-815
栏目:
论著
出版日期:
2014-04-30

文章信息/Info

Title:
Clinical outcome and impact factors of HBV-related patients’ relapse after nucleoside/nucleotide analogues withdrawal
作者:
袁婧张长江朱研王小红
第三军医大学西南医院全军感染病研究所,感染病研究重庆市重点实验室
Author(s):
Yuan Jing Zhang Changjiang Zhu Yan Wang Xiaohong
Institute of Infectious Diseases, Southwest Hospital, Chongqing Key Laboratory of Infectious Diseases Research, Third Military Medical University, Chongqing, 400038, China
关键词:
乙型肝炎病毒核苷(酸)类似物停药复发临床转归
Keywords:
hepatitis B virus nucleoside/nucleotide analogues withdrawal relapse clinical outcome
分类号:
R181.35;R512.62;R977
文献标志码:
A
摘要:
目的      研究乙型肝炎病毒相关肝病患者核苷(酸)类似物停药复发的临床特征、临床转归及其影响因素。      方法      回顾性分析2011年西南医院感染病科HBV感染相关肝病住院患者的临床资料,筛选符合以下入组条件:年龄18~65岁、既往服用核苷(酸)类似物时间≥6个月、各种原因停药后病情再次发作的入院患者。观察停药复发住院患者的好转、恶化率,既往抗病毒疗程、停药至病情发作时间、病情发作至入院时间,检测入院后的血清学、生化学、病毒学等指标,计量资料用t检验或非参检验,计数资料用χ2检验,影响因素采用Logistic 回归分析。      结果      152例符合入组条件的患者纳入研究,98%为自行停药。好转率82.2%(125/152),恶化率17.8%(恶化出院25例,死亡2例)。17.8%患者发生肝病相关的并发症。69.1%患者在服用核苷(酸)类似物1~3年后停药,停药后病情再次发作的中位时间为6(1~96)个月,74.3%患者在停药后1年内复发。入院后ALT均呈下降趋势,TBIL和PT在各组呈平行改变,好转组呈现两种模式:一种是两者稳定后下降,另一种是两者进行性下降;恶化/死亡组仅呈现一种模式:两者进行性升高。分析显示入院即诊断重型肝炎、停药至病情发作时间越短、复发时TBIL及PT值越高患者的临床转归越差(P<0.05),既往服用核苷(酸)类似物种类、HBeAg状态及反弹HBVDNA水平对患者的临床转归未见影响(P>0.05)。      结论      乙肝相关肝病核苷(酸)类似物停药复发的住院患者中近1/5病情恶化或死亡出院,TBIL与PT的动态变化有一定规律性,可预测其临床转归,停药至病情复发时间越早临床转归越差。
Abstract:
Objective      To investigate the clinical characteristics and outcome of hepatitis B virus (HBV)-related patients’ relapse after nucleoside/nucleotide analogues (NAs) withdrawal and its impact factors.       Methods      The clinical data of HBV-related inpatients of Southwest Hospital in 2011 were retrospectively analyzed. The patients who meet the following criteria: 18 to 65 years old, took NAs more than 6 months before withdrawal and admitted patients due to disease onset after NAs withdrawal were recruited, with 152 cases in total. The recovery and exacerbation rate, duration of treatment of prior NAs, time of drug withdrawal to illness onset, time of illness onset to admission, and parameters of serological, biochemical and virological tests after admission were studied.       Results      In the patients, 98% withdrew on their own purposes and 82.2% (125/152) recovered and were discharged from hospital, while 17.8% (27/152) were exacerbated, including two dead cases. 17.8% of the patients had liver disease-related complications. 69.1% took NAs for 1 to 3 years before withdrawal. The median time of drug withdrawal to illness onset was 6 months. 74.3% of the patients relapsed within one year after NAs withdrawal. The ALT level in all patients showed a decrease trend after admission, whereas TBIL and PT levels showed parallel changes in each group: two patterns in the recovery group, a steady-then-descending pattern and a progressively-descending pattern, and a progressively-elevating pattern in the exacerbated group. Diagnosed severe hepatitis on admission, shorter time of drug withdrawal to illness onset and higher TBIL level, and prolonged PT were negatively correlated with clinical outcome (P<0.05). NAs category, HBeAg state and rebounded HBV DNA level were not significantly relevant to clinical outcome (P>0.05).       Conclusion      About 1/5 of HBV-related inpatients relapsed after NAs withdrawal have poor clinical outcome. The dynamic changes of TBIL and PT level have some particular patterns, and may be used to predict the clinical outcome. Shorter time of NAs withdrawal to illness onset indicates worse clinical outcome.

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更新日期/Last Update: 2014-04-21