目的 观察HBV相关慢加急性肝衰竭(HBV-related acute-on-chronic liver failure,HBV-ACLF)患者接受核苷类似物抗病毒治疗过程中血清乳酸的变化并探讨其意义.方法 回顾性分析2009-2010年于我院治疗的74例HBV-ACLF患者的临床资料,分析乳酸升高与核苷类似物、感染、肝肾综合征以及生化指标的关系.结果 服用恩替卡韦或拉米夫定的2组患者乳酸升高比率的差异无统计学意义.乳酸水平升高与感染、肝肾综合征的发生有关(x2值分别为9.417和6.158,P值分别为0.002和0.013).临床无确切引起乳酸升高原因的3例患者,乳酸呈一过性升高,且预后良好.结论 HBV-ACLF患者抗病毒治疗过程中乳酸升高主要原因是感染和肝肾综合征.核苷类似物治疗HBV-ACLF未引发显著的乳酸升高,安全性良好.%Objective To evaluate the changes of serum lactate level and its significance in patients with HBV-related acuteon-chronic liver failure (HBV-ACLF) receiving nucleoside analogue antiviral therapy. Methods Clinical data of 74 HBV-ACLF patients treated in our hospital from 2009 to 2010 were retrospectively analyzed, and the relationship between increased serum lactate level and nucleoside analogues, infection, hepatorenal syndrome and biochemical indicators were evaluated. Results The proportions of the patients with increased lactate level were not siguificantly different between the patients receiving entecavir and those receiving lamivudine. The increased lactate level was related to the occurrence of infection(x2=9.417, P=0.002) and hepatorenal syndrome (x2=6.158, P=0.013). Only 3 patients had no other suspected causes of lacticemia, and the serum lactate levels in these patients returned to normal with good prognosis. Conclusions The increased lactate level in HBV-ACLF patients receiving antiviral therapy is mainly caused by infection and hepatorenal syndrome. Antiviral treatment with nucleoside analogues does not result in the increased lactate level in HBV-ACLF patients with sound safety.
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