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.docVIP

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 袁 婧，张长江，朱 研，王小红 (400038 重庆，第三军医大学西南医院全军染病研究所感染病研究重庆市重点实验室乙型肝炎病毒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(P0.05)，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(P0.05)。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。 [关键词] 乙型肝炎病毒；核苷(酸)类似物；停药；复发；临床转归 [中图法分类号] [文献标志码] A Clinical outcome and impact factors of HBV-related patients’ relapse after nucleoside/nucleotide analogues withdrawal? Yuan Jing, Zhang Changjiang, Zhu Yan, Wang Xiaohong (Institute of Infectious Diseases, Southwest Hospital, The Third Military Medical University; The Chongqing Key Laboratory For Research of Infectious Diseases, Chongqing, 400038, China) [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 dea