|
The first part of the nucleoside (acid) analogues of HBV-related chronic liver failure patients survival Objective: To assess the nucleoside (acid) analogues treatment of HBV-related chronic liver failure patients with recent survival analysis of HBV-related chronic liver failure factors in the prognosis of patients with HBV-related chronic liver failure patients Cox proportional hazards regression model. Methods: Subjects: collect more complete information hospitalized in the Third Hospital of Hebei Medical Shijiazhuang City Hospital from January 2003 to December 2010 HBV-related chronic liver failure patients were studied retrospectively. Case inclusion criteria: (1) in the diagnosis of cases of 2006 Chinese Medical Association, Infectious Diseases credits hepatic failure with artificial liver study group, Hepatology of Chinese Medical Association severe liver disease with artificial liver study group to develop liver failure treatment guidelines. \for simple routine medical treatment; (2) in the treatment group for routine medical treatment based on the addition of nucleoside analogues treatment (acid) control group; (3) the comparability of the two groups in terms of age, sex, illness balanced. Cases exclusion criteria: (1) with pregnancy and HAV, HCV, HDV, HEV, HIV, EBV, CMV and other viruses infected; (2) nucleoside (acid) analogues with TCM Drugs; (3) implementation of a surgical surgery or liver transplantation; (4) in patients with malignant tumors, severe immune system diseases, blood diseases, or apparent history of mental illness. The treatment: the treatment group for routine medical treatment based on the addition of nucleoside (acid) analogs (lamivudine, adefovir dipivoxil, TU entecavir and telbivudine given alone or in combination) therapy, the control group routine medical therapy alone. All patients periodically check liver function (ALT, AST, ALB, TB), coagulation (INR, PTA), serum creatinine (Scr), HBV viral markers (HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBc ) and HBV DNA level, continue after the patient's discharge follow-up treatment to 16 weeks. In this study, HBV DNA, ALT, AST, TB, ALB, PTA level, MELD score and mortality to determine indicators. Treatment outcomes are divided into: (1) improved: improved clinical symptoms, indicators of liver function, blood clotting, MELD score improved survival to 16 weeks; (2) deterioration: clinical symptoms, liver function, blood clotting and other indicators show sustained liver damage aggravated or serious complications and multiple organ failure, and 16 weeks after rescue invalid death. Statistical analyzes were performed using IBM SPSS Statistics 19 statistical software, measurement data (mean ± SD) and Levene test, homogeneity of variance (P gt; 0.05) is applied t-test to compare, if unequal variances (P lt; 0.05) is applied t 'test was used for comparison; count data using χ ~ 2 test. The calculation of the treatment and control groups before treatment and after treatment MELD score formula: MELD = 3.78 × [Ln TB (mg / dl)] 11.2 × [Ln INR] 9.57 × [Ln Sc (rmg / dl)] 6.43 × etiology (cholestatic or alcoholic to 0, and the other for 1). The calculation of the treatment group and the control group mortality of patients, and all of HBV-related chronic liver failure patients to establish the Cox proportional hazards regression model to analyze the impact of HBV-related chronic liver failure patients prognosis influencing factors. Results: Demographic and clinical data included in the cases: The study enrolled 186 patients with HBV-related chronic liver failure patients, 55 cases of the treatment group, 131 patients in the control group. Treatment group and control group patients' gender, age, underlying diseases of the liver, complications, onset incentives, HBV DNA load, ALT, AST, TB, ALB, PTA, MELD score difference was not statistically significant (P gt; 0.05 ). HBV DNA negative rate of the treatment group and the control group comparison: After 16 weeks of treatment, the treatment group HBV DNA negative in 26 cases, negative rate of 37.1%; HBV DNA negative control group in 1 case, the negative rate of 5.9 % (HBV DNA load lt; 500copies/ml regarded as negative). HBV DNA negative rate of treatment and control groups, the difference was statistically significant (χ ~~ 2 = 6.245, P = 0.012), suggesting that the nucleoside analogues (acid) can be suppressed HBV DNA replication, reduce HBV levels, improve HBV-related chronic liver failure in patients with HBV DNA negative rate. 3, liver function, blood coagulation function and MELD score of the treatment group and the control group after treatment comparison: after treatment compared with the control group, the treatment of patients with TB, the MELD score was significantly reduced, ALB level, PTA significantly higher percentage; treatment group after treatment patients with TB, ALB, PTA levels and MELD score and the control group a significant difference, (t t ') test P value lt; 0.05. After treatment, ALT, AST level treatment group and the control group showed no significant differences, t 'test P value gt; 0.05. The results showed that the application of the nucleos () analogue therapy significantly reduced the level of patients with TB, improve patient ALB, PTA level, lower MELD score had no significant effect on the level of ALT, AST: HBV-related chronic liver failure patients. Different combinations of mode of HBV-related chronic liver failure in patients with HBV viral markers: The study included 186 patients with HBV-related chronic liver failure in patients with HBV DNA were positive, HBV DNA load range of 8.12 × 102 ~~ 9.12 × 108 copies / ml, all patients had at least one HBV viral marker positive of HBsAg () HBeAg () HBeAb (-) patients account for all cases 43.0% of HBsAg () HBeAg (-) HBeAb () patients account for all cases 41.4% of HBsAg () of HBeAg (-) HBeAb (-) patients account for all cases 12.4% patients with HBsAg (-) HBeAg (-) HBeAb () accounted for 3.2% of all cases, different combinations of mode of treatment group and a control group of patients with HBV markers proportion significant differences (P gt; 0.05). 5, the mortality rate of the treatment group and the control group comparison: include all HBV-related chronic liver failure patients with a total of 186 cases, including 143 cases of the treatment group and the control group of 55 cases; After 16 weeks of treatment, all patients with a total of 99 cases of death in the treatment group 61 cases, the fatality rate was 46.6% in the control group of 38 patients, the mortality was 69.1%. The mortality rate of the treatment group and the control group the difference was statistically significant (χ to 2 = 7.895, P = 0.005), suggesting that the nucleoside (acid) the analogues can significantly reduce HBV-related chronic liver failure patients mortality and improve patient outcomes . 6 of HBV-related chronic liver failure patients Cox analysis: include all cases of survival time in days, 11 covariates were: nucleoside (acid) analogue treatment, gender, age, HBV viral markers combined mode ALT , AST, TB, ALB, PTA, HBV DNA load, MELD score. Single factor Cox regression analysis for each covariate, α = 0.05 level, gender, age, HBV viral marker combination mode, AST was no significant difference (P gt; 0.05); nucleoside analogue treatment (acid) ALT, TB, ALB, PTA, HBV DNA load, MELD score were significantly different (P lt; 0.05). There will be no significant differences in covariates removed significant differences in covariates nucleoside (acid) analogue therapy, ALT, TB, ALB, PTA, HBV DNA load, MELD score to do further multivariate Cox stepwise regression analysis, and gradually regression analysis found that the ALT the P = 0.823, the difference was not statistically significant, so ALT removed the remaining six covariates continue to do multivariate Cox stepwise regression analysis, results showed: nucleoside analogue treatment (acid), TB ALB, PTA, HBV DNA load, MELD score showed a significant difference (P lt; 0.05), prompted influential factors for HBV-related chronic liver failure patient survival: nucleoside analogues treatment (acid), TB ALB, PTA, HBV DNA load, MELD score. In this study, the Cox proportional hazards regression model expression: h (t, X) = h0 (t) exp (0.004 TB 0.343 HBV DNA 0.069 MELD - 0.901 NAs - 0.154 ALB - 0.048 PTA) (HBV DNA: log10, copies / ml; NAs: Application nucleoside analogues (acid) treatment 1, not application nucleoside (acid) analogue therapy 0), prognostic index PI = 0.004 TB 0.343 HBV DNA 0.069 the MELD - 0.901 NAs - 0.154 ALB - 0.048 PTA . Conclusion: nucleoside (acid) analogues can significantly improve HBVDNA seroconversion rate of HBV-related chronic liver failure patients, improve patient ALB, PTA level, the lower level of the patient's TB patients with low MELD score, reducing the risk of death in patients with reducing HBV-related chronic liver failure patients (16 weeks) no significant effect on mortality, while patients with ALT, AST decreased level. Of HBV-related chronic liver failure in patients with recent (16 weeks), prognosis of patients with HBV DNA load related to TB, ALB, PTA level, MELD score and nucleoside (acid) analogue therapy, HBV DNA load, TB levels and MELD score and low levels of ALB, PTA, not application nucleoside (acid) analogue therapy in patients with poor prognosis, gender, age, ALT, AST levels and HBV viral markers combined mode is the short-term prognosis of patients with no effect. Of HBV-related chronic liver failure patients with the Cox proportional hazards regression model expression: h (t, X) = h0 (t) exp (0.004 TB 0.343 HBV DNA 0.069 MELD - 0.901 NAs - 0.154 ALB - 0.048 PTA) (HBV DNA : log10, copies / ml; NAs: nucleoside analogues (acid) for 1, not nucleoside (acid) analogue therapy 0) prognostic index PI = 0.004 TB 0.343 HBV DNA 0.069 MELD - 0.901 NAs - 0.154 ALB - 0.048 PTA. Meta-analysis of the purpose of the second part of the nucleoside (acid) analogues term efficacy for the treatment of patients with chronic severe hepatitis B: Meta-analysis system evaluation nucleos (t) ide analogs to treat chronic severe hepatitis B term efficacy. : Retrieve in English literature published from 1990 to 2010 in Medline, PubMed, CNKI full-text database. Database, Chinese Biomedical Literature Database and other databases, and supplemented by literature goes back and manually retrieve the relevant References in strict accordance with the literature included exclusion criteria were included in the study, Meta-analysis using RevMan 5.0 statistical software applications forest plots, funnel plot, the loss of the safety factor of the decision index test, sensitivity analysis, and publication bias. Results: 20, English literature, a total of 1240 cases were included in the study, the therapeutic efficacy indicators: HBV DNA negative rate of RR = 3.37,95% CI (2.20,5.16), Z = 5.60 (P lt; 0.00001); of PTA WMD = 34.70,95% C (I25.62, 43.79), Z = 7.49 (P lt; 0.00001); ALB WMD = 4.73,95% C (I2.95, 6.51), Z = 5.21 (P lt; 0.00001); ALT WMD = -42.58,95% CI (-59.74, -25.41), Z = 4.86 (P lt; 0.00001); TB WMD = -150.95,95% CI (-199.29, -102.62), Z = 6.12 (P lt ; 0.00001); mortality RR = 0.55, 95% CI (0.48,0.64), Z = 8.09 (P lt; 0.00001). Conclusion: nucleos (t) ide analogs can significantly improve the chronic severe hepatitis B patients with HBV DNA negative conversion rate, improve the PTA, ALB level, lower ALT, TB level, which reduces mortality in patients with chronic severe hepatitis.
|