摘要目的 探讨防止乙型肝炎肝衰竭生存患者肝纤维化进展的方法.方法 在多中心选择亚急性或慢加亚急性乙型肝炎肝衰竭生存者(A组)100例随机分为3组,在度过肝衰竭后分别给予干扰素α、拉米夫定和拉米夫定联合苦参碱治疗6个月,选择慢性乙型肝炎肝衰竭生存者(B组)100例随机分为2组,分别给予拉米夫定和拉米夫定联合苦参碱治疗6个月.全部患者均随访6个月,观察血生物化学、血清学、病毒学和肝组织学应答情况.根据资料不同采用t检验和χ2检验进行统计学分析.结果 全部A组患者生存,B组接受拉米夫定治疗的患者死亡3例(6.1%),接受拉米夫定联合苦参碱治疗的患者死亡4例(7.8%,P＞0.05);B组患者在治疗结束时血清总胆红素水平未降至正常,拉米夫定治疗使超过90%患者血清HBV DNA阴转,A组接受干扰素α或拉米夫定联合苦参碱治疗的患者HBeAg/抗-HBe血清转换率分别为52.9%(9/17)和31.3%(5/16),均高于拉米夫定治疗者(1/17,5.9%);在A组接受拉米夫定治疗的患者在随访结束时肝组织Knodell HAI计分(7.2±0.8)低于干扰素α治疗者(8.2±1.3),P＜0.05;联合苦参碱治疗可使HAI计分进一步降低(6.9±0.7),差异有统计学意义(P＜0.01).拉米夫定或拉米夫定联合苦参碱治疗对B组患者能抑制肝内炎症病变,但对已形成的肝纤维化无明显的逆转作用. 结论 乙型肝炎肝衰竭生存患者长期口服核苷类抗病毒药对阻断肝硬化的形成有重要作用,适时联合苦参碱可提高HBeAg/抗-HBe血清转换率和抑制肝内纤维组织增生.

abstractsObjective To investigate the effect oflamivudine, interferon alpha and oxymatrine treatment for surviving hepatic failure patients with hepatitis B. Methods 200 hepatitis B patients, including 100 subacute or acute-on-chronic hepatic failure survivals (group A), and 100 chronic (group B, n = 100)hepatic failure survivals, were enrolled in this study. Patients in group A received interferon alpha (n = 35),lamivudine (n = 33), or combinational lamivudine and oxymatrine (n = 32) therapy for six months; Patients in group B received lamivudine (n = 49), or combinational lamivudine and oxymatrine (n = 51) therapy for six months, respectively. After the treatment, all patients were followed-up for six months. Results At the end of follow-up, all patients in group A survived, while in group B three patients (6.1%) receiving lamivudine,and four (7.8%, P ＞ 0.05) receiving combinational therapy died; more than 90% of all survivals had their HBV DNA loss. The HBeAg/anti-HBe seroconversion rate in patients of group A treated with interferon alpha (9/17, 52.9%) was higher than that in patients treated with combinational lamivudine and matrine (5/16,31.3%, P ＜ 0.05), which was higher than that in the patients treated with lamivudine alone (1/17, 5.9%, P ＜0.01), and the Knodell histological activity index score in patients treated with lamivudine (7.2 ± 0.8, P ＜ 0.05) was lower than that in patients treated with interferon alpha (8.2± 1.3, P ＜ 0.05), and the best efficacy was found in receiving combinational therapy (6.9 ± 0.7, P ＜ 0.01); Lamivudine or lamivudine in combina-tion with matrine significantly inhibited the intrahepatic inflammatory activities, but had no effect on the existing fibrosis in group B patients. Conclusion Long term nucleotide analogues treatment may delay the progress of fibrosis in hepatitis B-induced hepatic failure survivals, and the administration of matrine in time may further enhance the anti-fibrotic effect of nucleotide analogues.