ABSTRACT
Objective To analyze the prognostic factors for patients with hepatic encephalopathy (HE) in acute-on-chronic liver failure(ACLF).Methods A retrospective analysis was performed on 159 ACLF patients with HE.The hepatic encephalopathy was determined to baseline,the patients were divided into survivors(n =13) and nonsurvivors(n =146),The 32 factors affecting the prognosis were analyzed by Cox proportional hazard model with SPSS.Results One-month,three-month,and six-month survival rates were 20.13％,10.06％ and 8.18％,respectively.Cox regression analysis of prognostic factors showed that it could the stage of hepatic encephalopathy and HRS significantly improve the survival rate of the patients with HE in acute-on-chronic liver failure.The stage of hepatic encephalopathy and HRS could significantly decrease the survival rate of the patients(x2 =18.344,11.368,all P ＜ 0.05),elevated the levels of hepatic encephalopathy (relative risk (RR) =1.591) and HRS (RR =1.809) indicate worse prognosis with hepatic encephalopathy in acute-on-chronic failure.Conclusion The stage of hepatic encephalopathy and HRS were independent risk factor sof prognosis in acute-on-chronic liver failure.
ABSTRACT
Objective To study the clinical curative effect of adefovir and lamivudine in the treatment of chronic hepatitis B .Methods 68 patients with chronic hepatitis B were randomly divided into the treatment group and control group,34 cases in each group.The treatment group was treated with adefovir and lamivudine for 48 weeks,the control group was treated by lamivudine for 48 weeks.12,24,36,48 weeks after treatment ,the changes of liver func-tion,ALT index in HBV DNA,HBV DNA and the changes of serum HBeAg negative rate ,HBeAg/HBeAb seroconver-sion rate and adverse reaction were observed and compared .Results With the extension of treatment time ,ALT,HBV DNA in the two groups were gradually decreased , there were significant differences before and after treatment ( t=4.63,4.65,P<0.05).24,36,48 weeks after treatment,ALT,HBV DNA in the treatment group were significantly lower than those in the control group[ALT (89.9 ±16.7) U/L,(60.1 ±13.8) U/L,(44.6 ±8.9) U/L vs (90.7 ± 17.6) U/L,(72.0 ±14.1) U/L,(61.3 ±24.5) U/L;HBV DNA (4.92 ±1.44) U/L,(3.35 ±1.37) U/L,(2.53 ± 1.31) U/L vs (5.02 ±1.41) U/L,(3.69 ±1.40) U/L,(3.02 ±1.35) U/L],there were significant differences between two groups(F=4.32,4.56.4.76,all P<0.05).After treatment,the HBV DNA and HBeAg negative con-version rate,HBeAg/HBeAb seroconversion rate in two groups were increased significantly ,the differences were statis-tically significant(χ2 =4.63,4.36,4.21,4.27,4,35,4.23,all P<0.05).At the 24th week of treatment,the serolog-ical markers of HBV had no significant difference , but after 24 weeks, serum markers in the treatment group (67.65%,32.35%,26.47%,85.29%,38.23%,35.29%) were obviously higher than those in the control group , the differences between the two groups were significant (χ2 =4.43,4.73,4.23,4.32,4.34,4.46,4.76,4.34,4.22, 4.29,4.34,4.45,all P<0.05).Conclusion Adefovir and lamivudine combination therapy in the treatment of chro-nic hepatitis B has obvious clinical effect ,has no serious adverse reactions ,which is suitable for clinical application .