Efficacy Of Different Antiretroviral Drugs In Patients With Chronic Hepatitis B Virus Related Acute-on-chronic Liver Failure

ObjectiveTo observe the therapeutic effects of Lamivudine (LAM), Entecavir (ETV),Lamivudine combined with Adefovir Dipivoxil in patients with hepatitis B virusrelated acute-on-chronic liver failure (HBV-ACLF) in early-to-mid stage.Thefollow-up end-time was24weeks. The purpose of this study is to find a safe,effective and affordable antiviral treatment and to rapidly control the symptoms of thepatients with acute-on-chronic liver failure caused by HBV, and to buy the time forthe subsequent treatment and hepatocyte regeneration,so reduce the mortality of liverfailure patients.MethodsCollect the clinical data and follow-up records of89patients with HBV-ACLF inearly-to-mid stage who were hospitalized in the department of infectious disease ofthe first affiliated hospital of Zhengzhou university from the December2010to June2013.Among the89cases,25cases received Entecavir antiviral treatment,42caseswere treated with Lamivudine, Meanwhile22cases were treated with Lamivudinecombined with Adefovir Dipivoxil.we adopt the method of retrospective analysis the data Of all the patients, we observed these patients in0,4,8,12,24weeks for thechanges of their main indexes of liver function, viral response, appear all sorts of riskof complications,overall mortality and the cumulative survival rate changes, thenchoose the best antiviral treatment.Results1. There were no statistical significance among the patients in the three groups interms of demographic characteristics and initial clinical indicators（P>0.05）2. The level of ALT in the three groups were all significantly down-regulated afterthe24-week treatment compared with before (P<0.001)3. Compared with the baseline, the TBil of the patients in ETV group had beenrising steadily for2,4weeks, and begun to decrease at the end of4thweek. Thesimilar variation trend was observed in the LAM group and combined group.After24weeks, the TBil of the patients in three groups significantly decreased(P<0.001).4. Compared with the baseline, the PAT level of the people in three group weresignificantly increased After the24-week treatment(P<0.05).5. The concentration of HBV-DNA of the patients in the three groups were fallingfast in4weeks after treatment compared with the baseline （P<0.001）.6. The level of HBV-DNA was dropping greatly after receive Entecavir24weekstreatment when compaired with combined group（P=0.0022）.7. At the end of follow-up in group ETV, the level of HBV-DNA was below thedetection limit. Furthermore, the HBV-DNA negative conversion rate in ETVgroup, LAM group and combined group were62.5%,25%and16.7%respectively. There were significant differences in HBV-DNA negativeconversion rate among the three groups (P <0.05).8. After24weeks,9cases died and the mortality rate was36%in the Entecavirgroup,10patients died and the death rate was23.8%in the Lamivudine treatmentgroup and in the Combined group, there have10cases died, the mortality rate was45.5%,that making no statistical difference.In these died of various complications patients of three groups, there was no statistically difference（P>0.05）9. The survival rate in ETV group, LAM group and combined group were64%,76.2%and54.5%respectively. There wasn’t significant difference in survivalrate among the three groups (P <0.05).ConclusionThe three antivirus treatment programs can decrease the levels of ALT, TBil,HBV-DNA and other clinical indicators of HBV-ACLF patients and promote therecovery of liver function. Though there weren’t significant differences in24-weekmortality and cumulative survival rate among the three groups, Entecavir couldachieve a better virological response in the long run.