Lamivudine versus entecavir for patients with HBeAg-negative acute-on-chronic liver failure / 中华传染病杂志

ABSTRACT

Objective To evaluate the short-term efficacy of lamivudine versus entecavir for patients with HBeAg-negative acute-on-chronic liver failure (ACLF) with different pretreatment liver failure degrees.MethodsA total of patients with HBeAg-negative ACLF were enrolled into this retrospective study.Seventy-two cases were treated with lamivudine 100 mg daily,while 93 cases were treated with entecavir 0.5 mg daily.Biochemical items,model for end-stage liver disease (MELD)score,hepatitis B virus (HBV) DNA level and mortality were observed.The efficacies of the two drugs were analyzed in patients with different degrees of liver failure.The comparison of rates was done using chi-square test and the measurement data were compared by t test.ResultsAmong the patients with pretreatment MELD scores above 30,the post-treatment HBV DNA levels in lamivudine group and entecavir group were (3.6 ± 1.1) lg copy/mL and (3.7 ± 1.4) lg copy/mL,respectively (t=0.181,P=0.859) and the mortalities were 92.0％ and 91.8％,respectively (χ2 =0.002,P=0.680).For the patients with pretreatment MELD scores from 23 to 30,the post-treatment HBV DNA levels in two groups were (3.2± 1.1) lg copy/mL and (3.2±2.3) lg copy/mL,respectively (t=0.760,P=0.455) and the mortalities were 42.9％,54.1％,respectively (χ2 =0.799,P=0.455).In patients with pretreatment MELD scores below 23,the post-treatment HBV DNA levels in two groups were (3.1±1.0) lg copy/mL and (2.8±1.5) lg copy/mL,respectively (t=-0.740,P=0.464) and the mortalities were 3/19 and 6.3％,respectively (χ2=1.227,P=0.455).In lamivudine group,the mortalities were significantly different among patients with three different ranges of pretreatment MELD scores (χ2 =26.967,P =0.000).The similar differences were also found in entecavir group (χ2 =41.260,P=0.000).ConclusionsAmong treatment na?ve patients with HBeAg-negative ACLF,the short-term efficacy of lamivudine versus entecavir is equal if the degree of pretreatment liver failure is similar.Meanwhile,the degrees of pretreatment liver failure significantly affects the outcome of the treatment.