e抗原阴性慢性乙肝老年患者核苷类药物停药后的临床和病毒学复发评估

发布时间：2018-07-13 12:42

【摘要】：目的探讨分析e抗原阴性慢性乙肝老年患者核苷类药物停药后的临床及病毒学复发情况。方法选取78例e抗原阴性慢性乙肝老年病患展开调查研究,根据病患服用药物的种类分为拉米夫定(LMV)组18例,阿德福韦酯(ADV)组19例,恩替卡韦(ETV)组21例,ETV+ADV组20例,分析病患的临床症状、服用药物的种类、疗程、停药原因、停药后的复发情况及病毒、血清学等指标。结果 LMV组,停药时间2个月~3年;ADV组,停药时间2个月~3年;ETV组,停药时间1个月~2年;ETV+ADV组,停药时间2个月~1年。停药6~12个月复发人数明显多于其他阶段复发人数,24个月累积复发出现的人数较多,对比差异显著(P0.05),慢性中度肝炎病患复发34例,慢性重度肝炎病患复发22例,慢性重型肝炎病患复发11例,代偿性肝硬化复发7例,4例失代偿性肝硬化复发4例。慢性重度肝炎病患和慢性重型肝炎患者ALT、AST、凝血酶原时间(PT)指标都明显比其他组高(P0.05)。结论 e抗原阴性慢性乙肝老年病患核苷类药物停药后多在6~12个月以内复发,复发后对肝造成的损伤更严重。医护人员应根据病患的实际情况指导用药,以获得稳定的效果。
[Abstract]:Objective to investigate the clinical and virological recurrence of nucleoside drugs in elderly patients with chronic hepatitis B with negative e antigen. Methods Seventy-eight elderly patients with chronic hepatitis B with negative e antigen were divided into lamivudine (LMV) group (n = 18), adefovir ester (ADV) group (n = 19) and entecavir (ETV) group (n = 21). The clinical symptoms, the kinds of drugs taken, the course of treatment, the reasons of withdrawal, the relapse after withdrawal, the virus, serology and so on were analyzed. Results in the LMV group, the withdrawal time was 2 months ~ 3 years, the withdrawal time was 1 month ~ 2 years, and the withdrawal time was 2 months ~ 1 year. The number of relapses in 6 ~ 12 months after withdrawal was significantly higher than that in other stages, and the cumulative recurrence in 24 months was more than that in other stages (P0.05). 34 patients with chronic moderate hepatitis and 22 patients with chronic severe hepatitis recurred. There were 11 cases of recurrence of chronic severe hepatitis and 4 cases of decompensated cirrhosis in 7 cases of compensatory cirrhosis. The indexes of alt AST and prothrombin time (PT) in patients with chronic severe hepatitis and chronic severe hepatitis were significantly higher than those in other groups (P0.05). Conclusion the nucleosides in elderly patients with chronic hepatitis B with negative e antigen usually recur within 6 ~ 12 months after withdrawal, and the liver damage is more serious after recurrence. The medical staff should guide the medication according to the actual condition of the patient to obtain the stable effect.
【作者单位】：临安市人民医院感染科结核病门诊;浙江大学附属第一医院传染病科;
【分类号】：R512.62

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