Studies On Prognosis Of Patients With Liver Failure And Evaluation Of The Efficacy Of Optimized Treatment For Chronic Hepatitis B

Objective1. To review retrospectively confer to the new standard of ALF etiologic factors andprognosis in patients with acute liver failure.2. To investigate clinical efficacy，the consequences of artificial liver support systemtreatment and influence factors of prognosis in patients with HBV related ACLF.3. To evaluate the efficacy of Optimized strategy for HBeAg-position chronichepatitis B patients with lamifudine resistance receiving ADV plus LAM or ADVmonotherapy.Methods1. A total of61in ALF patients were identified. The causes，laboratory profiles，prognosis in patients with acute liver failure were investigated.2. There were a total of56in HBV-ACLF patients in the research. According togender and age.，there were28patients who received ALSS in observation groupcases,28patients in control group. The laboratory profiles and prognosis in two groups were investigated.3.79chronic hepatitis B patients with LAM resistance were ramdomly put in anobservation group or a control group. After24weeks of treatment, serum HBVDNAlevels were measured and Normalization of ALT, drug resistance were also conducted.Results1. The most common etiology of ALF in Hubei province and neighboring regions wasHBV induced in85.2%. Besides ALT and Cr, there are significant differences in age,Alb, total bilirubin, the serum sodium level, PT and INR in the death group comparedwith that in the control group.2. After44times ALSS treatment in the28patients, most of the laboratory profilesand the clinical symptoms of all patients were ameliorated(P<0.05). The survival inobservation group and other group for1month was89.29%and78.57%,respectively. There is no significant improvent in survival rate were investigatedbetween the two groups (P>0.05). TBil, creatinine, PT, international normalized ratio,HE, HRS and age were important prognostic factors.3. Elevated ALT levels was a strong predictor of HBeAg loss. Patients with baselineVirological response at24weeks occurred in56.88%in the ALT≥2ULN groupcompared with73.22%in the HBVDNA levels <8log10copies/ml and ALT≥2ULNgroup(P<0.05). Normalization of ALT at24weeks occurred in70.07%in theobservation group compared with69.44%in the control group(P>0.05). Virologicalresponse at24weeks occurred in60.46%in the observation group compared with52.78%in the control group(P>0.05). Lower emergence rate of the ADV-associatedmutants at24weeks was observed in LAM plus ADV compared to ADVmonotherapy(4.65%vs13.89%)(P <0.05).Conclusion1. The most common etiology of ALF was HBV infected in Hubei province andneighboring regions. Age, albumin, total bilirubin, the serum sodium level, prothrombin time and international normalized ratio are important prognosticfactors.2. ALSS can improve clinical symptoms and the laboratory profiles of patients withHBV related acute-on-chronic liver failure. But ALSS can not increase survival. Age,total bilirubin, international normalized ratio, HE and HRS are important prognosticfactors.3. Elevated ALT levels are a well predictor of HBeAg loss. There is no significantimprovent in virological response and ALT normalization are observed between thetwo groups. The combination of LAM with ADV is superior in preventing drugresistance as compared to ADV alone for LAM-resistant HBeAg-positive CHBpatients.