目的 评价慢性重型乙型肝炎(CSHB)患者短期抗病毒治疗的临床效果.方法 回顾性分析83例CSHB患者的病历资料:57例采用抗病毒治疗+内科综合治疗+人工肝治疗(组1),26例采用内科综合治疗+人工肝治疗(组2),观察2组患者血清丙氨酸转氨酶(ALT)、总胆红素(TBIL)、凝血酶原时间活动度(PTA)、乙型肝炎病毒(HBV) DNA载量的好转情况.结果 经过2～4周的治疗,组1患者ALT、TBIL、PTA、HBV DNA的下降值等与组2比较,差异均有统计学意义(均P＜0.05)；组1的治疗好转率为78.95％(45/57),组2为57.69％(15/26),两组差异有统计学意义(x2=4.14,P＜0.05).在组1中,替比夫定与恩替卡韦2种药物治疗好转率分别为69.57％(16/23)和68.42％(13/19),差异无统计学意义(x2=0.01,P＞0.05).结论 抗病毒治疗可提高CSHB的临床治疗效果,尤其可改善早、中期CSHB患者的预后；恩替卡韦、替比夫定均可用于此类患者的治疗.%Objective To evaluate the clinical efficacy of antiviral therapy in patients with chronic severe hepatitis B (CSHB). Methods Eight-three patients with CSHB were divided into 2 groups,57 patients of group 1 (antiviral group) received antiviral treatment plus comprehensive internal medicine treatment and liver support therapy, 26 patients of group 2 (non-antiviral group) received only comprehensive internal medicine treatment plus liver support therapy, the improvement rate of alanine transaminase (ALT), total bilirubin (TBIL),prothrombin time activity (PTA), and HBV DNA load in two groups of patients were observed. Results After 2 - 4 weeks of treatment,the declined values of ALT, TBIL, PTA, and HBV DNA in group 1 were significantly different from group 2 (all P< 0.05); improvement rate of group 1 and 2 was 78. 95% (45/57) and 57. 69% (15/26) respectively (χ2=4. 14, P< 0. 05). In group 1, treatment efficacy of telbivudine and entecavir was 69. 57%(16/23) and 68. 42%( 13/19) respectively (χ2 = 0. 01, P>0. 05). Conclusion Antiviral therapy can significantly improve the treatment efficacy of CSHB, early application can improve the prognosis; entecavir and telbivudine can be used for the treatment.
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