Entecavir treatment in patients with severe acute exacerbation of chronic hepati

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  Journal of Hepatology
Volume 54, Issue 2, February 2011, Pages 236-242
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doi:10.1016/j.jhep.2010.06.043 Copyright © 2010 European Association for the
Study of the Liver Published by Elsevier Ireland Ltd.    Cited By in Scopus (0)
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Research Article
Entecavir treatment in patients with severe acute exacerbation of chronic
hepatitis B

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references and further reading you must purchase this article.

Vincent Wai-Sun Wonga, b, Grace Lai-Hung Wonga, b, Karen Kar-Lum Yiua, b, Angel
Mei-Ling Chima, b, Shirley Ho-Ting Chua, b, Hoi-Yun Chana, b, Joseph Jao-Yiu
Sunga, b and Henry Lik-Yuen Chan, a, b, a Department of Medicine and
Therapeutics, The Chinese University of Hong Kong, Hong Kong b Institute of
Digestive Disease, The Chinese University of Hong Kong, Hong Kong

Received 29 April 2010;  revised 28 June 2010;  accepted 29 June 2010.  
Available online 7 September 2010.

Background & Aims
Severe acute exacerbation of chronic hepatitis B is a unique clinical
presentation with significant morbidity and mortality. Lamivudine was used in
most previous studies, but the drug was limited by the development of
resistance. Our objective is to study the safety and efficacy of entecavir in
patients with severe acute exacerbation.

Methods
Consecutive patients with severe acute exacerbation of chronic hepatitis B were
recruited from 1998 to 2009. All patients had serum alanine aminotransferase and
bilirubin increased beyond 10 and 3 times the upper limit of normal,
respectively. The primary endpoint was overall mortality at week 48. Virological
and biochemical responses were also studied.

Results
Thirty-six patients and 117 patients were treated with entecavir and lamivudine,
respectively. By week 48, 7 (19%) patients in the entecavir group and 5 (4%)
patients in the lamivudine group died (adjusted hazard ratio 5.1, 95% confidence
interval 1.5–17.2, p = 0.010). Similarly, the entecavir group had higher
liver-related mortality (adjusted hazard ratio 4.0, 95% confidence interval
1.0–15.7, p = 0.044). Despite a lower prevalence of cirrhosis, more patients
in the entecavir group developed prolonged jaundice, hepatic encephalopathy, and
ascites. Entecavir resulted in more rapid and complete viral suppression, with
71% of patients achieving undetectable hepatitis B virus (HBV) DNA at week 48,
compared to 40% in the lamivudine group (p = 0.007). However, rapid HBV DNA
reduction at week 4 was associated with prolonged jaundice.

Conclusions
Entecavir treatment is associated with increased short-term mortality in
patients with severe acute exacerbation of chronic hepatitis B but achieves
better virological response in the long run.

中华肝脏病杂志
54卷，第2期，2011年2月，页236-242
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分类号：10.1016/j.jhep.2010.06.043版权所有© 2010年的欧洲协会
肝脏研究由Elsevier出版有限公司通过图书馆论坛爱尔兰（0）引用
许可和重印

研究论文
恩替卡韦治疗慢性重症患者急性发作
B型肝炎

参考文献和可能提供进一步阅读本文。要查看
参考和进一步阅读你必须购买这篇文章。

文森特炜孙旺厄，乙，格雷斯赖宏旺厄，乙，卡伦嘉绥Yiua，乙，安琪
美泠笞蚂，乙，雪莉何挺蔡，乙，海恽叉衲，乙，约瑟夫饶耀
Sunga，B和亨利力元陈甲，乙，一个医学系及
疗法，香港中文大学，香港B研究所
消化系统疾病，香港，香港中文大学

收到2010年4月29日，经修订的2010年6月28日，接受2010年6月29日。
可在线2010年9月7日。

背景和目的
严重的慢性乙型肝炎急性发作是一个独特的临床
表现有显着的发病率和死亡率。拉米夫定是用于
以往大多数研究，但该药物是有限的发展
阻力。我们的目标是研究恩替卡韦的安全性和疗效
重症急性发作。

方法
重症慢性乙型肝炎急性发作患者进行连续
招募1998至2009年。所有患者的血清谷丙转氨酶和
胆红素升高超过10倍和3倍正常上限，
分别。主要终点是总死亡率为48周。病毒学
生化反应进行了研究。

结果
三十名病人和117例接受恩替卡韦和拉米夫定，
分别。到48周，7（19％）在恩替卡韦组患者5例（4％）
在拉米夫定组患者死亡（调整危险比5.1，95％的信心
区间1.5-17.2，p值= 0.010）。同样，恩替卡韦组有较高的
肝脏相关死亡率（调整危险比4.0，95％置信区间
1.0-15.7，p值= 0.044）。尽管肝硬化的发生率较低，更多的患者
在恩替卡韦组制定长期性黄疸，肝性脑病，并
腹水。恩替卡韦导致更多的快速，全面的病毒抑制，与
不到71％，实现乙型肝炎病毒（HBV）DNA的患者在48周，
相比40％的拉米夫定组（P = 0.007）。然而，飞速的乙型肝炎病毒DNA
在第4周下降是与长期性黄疸。

结论
恩替卡韦治疗会增加短期死亡率
重症慢性乙型肝炎急性发作患者，但实现
更好的病毒学反应的长远目标。




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