摘要目的：探讨慢性乙型肝炎并急性肝功能衰竭（慢加急）的治疗方法，分析快速高效抑制HBV复制的核苷类似物应用于慢加急患者的治疗结果，从免疫学角度对可能存在的机理进行研究。方法62例HBV DNA（＋）的慢加急患者中的32例给与保肝、促肝细胞再生等综合性治疗（对照组），另外的30例治疗方案同对照组外，还接受了一种快速高效抑制HBV复制的核苷类似物治疗（治疗组）。检测每组患者治疗前、治疗2周和4周时血HBV DNA，CD4＋T、CD8＋T淋巴细胞，补体C3、C4，肝功能衰竭指标TBIL、PTA水平，统计两组患者死亡率。结果治疗前，所有患者HBV DNA均阳性；两组间CD4＋、CD8＋、C3、C4、TBIL、PTA水平相似。治疗2周时，治疗组HBV DNA阴转率为90.0％（27/30），而对照组仅为9.4％（3/32）（χ2＝37.14， P ＜0.01）；两组间CD4＋、CD8＋、C3、C4、TBIL、PTA水平仍然相似。治疗4周时，治疗组 HBV DNA 阴转率为96.7％（29/30），对照组为12.5％（4/32），两组比较差异有统计学意义（χ2＝40.74， P ＜0.01）；在CD4＋、CD8＋、C3、C4、TBIL、PTA水平等方面也出现了明显差异：治疗组CD4＋（495.33±89.91） cells/ml高于对照组（270.34±97.74）cells/ml（ t ＝9.42， P ＜0.01），CD8＋（571.03±120.15）cells/ml高于对照组（224.88±79.68） cells/ml（ t ＝13.45， P ＜0.01）；治疗组C3（0.28±0.11）g/L低于对照组（0.68±0.13）g/L（ t ＝13.13， P ＜0.01），C4（0.12±0.06）g/L低于对照组（0.23±0.10）g/L（ t ＝4.92， P ＜0.01）；治疗组TBIL（653.93±131.02）μmol/L高于对照组（285.63±154.63）μmol/L（ t ＝10.09， P ＜0.01），PTA （17.13±7.07）％低于对照组（50.94±13.68）％（ t ＝12.10， P ＜0.01）。12周后统计患者死亡率，治疗组为57.9％，高于对照组的28.1％（χ2＝6.39， P ＜0.05）。结论快速高效核苷类似物应用于乙型肝炎慢加急患者的治疗，在短期内抑制了HBV复制， HBV对机体免疫抑制被部分解除，肝脏免疫损伤更加明显，肝功能衰竭更加难以恢复，死亡率增加。

abstractsObjective To analyze the result of treatment for acute-on-chronic liver failure patients with fast high efficiency Nucleoside and to explore the relations among inhibition to virus replication , liver failure development and immune rejection .Methods Sixty-two cases of acute-on-chronic liver failure pa-tients with HBV DNA(+) were divided into study group (treated with a kind of fast and nucleoside , n =30) and control group( n =32).HBV DNA,CD4 +T,CD8 +T, C3,C4 TBIL,PTA were observed at treat-ment 0w,2w and 4w.Results All of the study and control group patients , serum HBV DNA were positive before treated.And the levels of CD4+,CD8 +,C3,C 4,TBIL,PTA of study group were not significantly compared with control group .At treatment 2w , the rate of HBV DNA diverted negative in study group 90.0%(27/30), was significantly more then control group (9.4%, 3/32)(χ2=37.14 , P <0.01).But the CD4 +,CD8 +,C3,C4,TBIL,PTA levels were not significantly however between study and control group . At treatment 4w ,the rate of HBV DNA diverted negative in study group (96.7%, 29/30), was significant-ly more then control group(12.5%,4/32) (χ2 =40.74, P <0.01).CD4 +, CD8 +,C3,C4,TBIL,PTA levels of the study group were significantly more compared with the control group .The CD4 +level of study group (495.33 ±89.91)cells/ml, was higher significantly then control group (270.34 ±97.74)cells/ml( t=9.42, P <0.01),the CD8 +level (571.03 ±120.15 ) cells/ml, was higher significantly then control group(224.88 ±79.68)cells/ml( t =13.45, P <0.01).The C3 level of the study group (0.28 ±0.11) g/L, was lower significantly then control group ( 0.68 ±0.13 ) g/L ( t =13.13 , P <0.01 ) , the C4 level (0.12 ±0.06)g/L, was lower significantly then control group (0.23 ±0.10)g/L( t =4.92, P <0.01). The TBIL level of study group ( 653.93 ±131.02 )μmol/L, was higher significantly then control group (285.63 ±154.63)μmol/L( t =10.09, P <0.01),the PTA level (17.13 ±7.07)%, was lower signifi-cantly then control group(50.94 ±13.68)%( t =12.10, P <0.01).The death rate of the study group( 57.9%) was higher significantly compared with the control group (28.1%)(χ2 =6.39, P <0.05).Con-clusion Treatment of chronic severe hepatitis with fast and high efficiency nucleoside may arise the T cell subset level and make the immune rejection strength , as a result the liver failure maybe far away from cure .