慢性乙肝患者拉米夫定耐药后出现肝功能衰竭的危险因素_医学论文.docVIP

慢性乙肝患者拉米夫定耐药后出现肝功能衰竭的危险因素_医学论文 慢性乙肝患者拉米夫定耐药后出现肝功能衰竭的危险因素_医学论文 作者：邓洪， 顾 琳， 赵志新， 张晓红， 彭晓谋， 高志良 【摘要】 【目的】探讨慢性乙型肝炎患者拉米夫定耐药后出现肝功能衰竭的危险因素。【方法】拉米夫定耐药后导致病情加重的慢性乙型肝炎患者56例纳入研究，记录拉米夫定治疗前病程、诊断、拉米夫定疗程，检测并记录临床耐药时的肝功能、乙肝两对半、HBV DNA定量、YMDD 变异及前C区变异。按病情加重后的诊断分为肝功能衰竭组和慢性乙型肝炎组进行比较。【结果】肝功能衰竭组患者年龄(45±13)岁，大于慢性乙型肝炎组(37±13)岁（P lt 0.05）；肝功能衰竭组临床耐药时HBV DNA载量高于慢性乙型肝炎组[(2.8×108±4.9×108)拷贝/mL vs（3.1×106±2.9×106 ）拷贝/mL；P lt 0.05］；肝功能衰竭组出现HBeAg/ Anti-HBe血清学转换（54.6％）高于慢性乙型肝炎组（18.4%，P lt 0.05)。年龄和拉米夫定治疗前诊断为肝硬化都是耐药后出现肝功能衰竭的独立危险因素。【结论】 拉米夫定治疗前年龄大、诊断为肝硬化，临床耐药时病毒载量高，耐药后出现HBeAg/ Anti-HBe血清学转换可能是拉米夫定治疗耐药后出现肝功能衰竭的危险因素。有肝硬化基础患者一旦发生耐药变异，应及时使用能治疗耐药变异的阿德福韦或恩替卡韦。 【关键词】 慢性乙肝； 拉米夫定； 停药耐药； 肝功能衰竭 Abstract: 【Objective】 To investigate the risk factors of liver failure due to lamivudine resistance in the patients with chronic hepatitis B. 【Methods】 Fifty-six cases with acute exacerbation in chronic hepatitis B patients due to lamivudine resistance were investigated. The age and the diagnosis of the disease before lamivudine therapy, the liver function, HBsAg, HBsAb，HBeAg，HBeAb，HBcAb, HBV DNA load, the rate of YMDD mutation and pre-C mutation were also recorded. All cases were divided into liver function failure group and chronic hepatitis B group when flared, and each factor in the 2 groups was compared. 【Results】 The patients in liver function failure group were elder in age (P lt 0.05). The HBV DNA load detected when flared in liver function failure group were higher than those in chronic hepatitis B group [(2.8×108±4.9×108) copies/mL vs (3.1×106±2.9×106 ) conpies/mL，P lt 0.05］. The rate of HBeAg seroconversion in liver function group (54.6%) was higher than the rate in chronic hepatitis B group (18.4%， 0.05). Analyzed with binary logistic regression, the age and the diagnosis as liver cirrhosis before lamivudine therapy were both the isolated risk factors of liver function failure due to lamivudine resistance.【Conclusions】 Diagnosed as liver cirrhosis and aged before lamivudine therapy, high virus load when fla