Tenofovir improves the outcome in patients with spontaneous reactivation of hepa

StephenW

Hepatology. 2010 Dec 14. doi: 10.1002/hep.24109. [Epub ahead of print]

Tenofovir improves the outcome in patients with spontaneous reactivation of
hepatitis B presenting as acute-on-chronic liver failure.

Garg H, Sarin SK, Kumar M, Garg V, Sharma BC, Kumar A.
From the Department of Gastroenterology, GB Pant Hospital, New Delhi, India;
Department of Hepatology, Institute of Liver & Biliary Sciences (ILBS), New
Delhi, India.

Abstract
Spontaneous reactivation of chronic hepatitis B (CHB) is an important cause of
acute-on-chronic liver failure (ACLF). Antiviral drugs may help reduce the high
morbidity and mortality in such patients, especially in places where liver
transplant is not available. The aim was to evaluate the efficacy of tenofovir
and to determine the predictors of mortality in patients with spontaneous
reactivation of CHB with ACLF. Consecutive patients of ACLF due to spontaneous
reactivation of CHB were randomized to receive either tenofovir or placebo. The
primary endpoint was survival at 3 months. Of the 90 patients with ACLF of
different etiologies, 27 (26%) were due to reactivation of CHB and were
enrolled. The median baseline hepatitis B virus (HBV) DNA level was 9 × 10(5)
IU/mL. Fourteen patients received tenofovir and 13 placebo. At 3 months the
probability of survival was higher in the tenofovir than the placebo group (8/14
[57%] versus 2/13 [15%], respectively; P = 0.03). The cause of death in the 15
patients was progressive liver failure leading to multiorgan failure. Liver
transplantation could not be offered due to its nonavailability. In the
surviving patients, there was a significant improvement in the Child-Turcotte
Pugh (CTP) and model for endstage liver disease (MELD) scores and significant
decline in the HBV DNA levels in the tenofovir group, whereas these parameters
did not change significantly in the placebo group. More than 2 log reduction in
HBV DNA levels at 2 weeks was found to be an independent predictor of survival.
Conclusion: Tenofovir significantly reduces HBV-DNA levels, improves CTP and
MELD scores, and reduces mortality in patients with severe spontaneous
reactivation of CHB presenting as ACLF. Reduction in HBV-DNA levels at 2 weeks
should be a desirable goal and is a good predictor of survival.

(HEPATOLOGY 2011;.).
杂志。 2010年12月14日。分类号：10.1002/hep.24109。 [EPUB的提前打印]

泰诺福韦提高了患者的自发激活的结果
B型肝炎以急性上，慢性肝功能衰竭。

Garg小时，沙林水库，库马尔男，Garg五，夏尔马年，库马尔答
从消化内科，国标潘特医院，新德里，印度;
部门肝病，肝及（ILBS）胆道科学研究所，新
印度新德里。

摘要
慢性乙型肝炎（CHB）自发恢复是一个重要的原因
急性上慢性肝功能衰竭（ACLF）。抗病毒药物可能有助于降低高
此类病人的发病率和死亡率，特别是在地方，在那里肝
移植是不可用。这样做的目的是评估疗效的泰诺福韦
并确定患者死亡率的预测自发
恢复与ACLF慢性乙型肝炎。患者由于连续的ACLF自发
慢性乙型肝炎恢复被随机接受替诺福韦或安慰剂。该
主要终点是生存在3个月。与ACLF的90例
不同的病因，27（26％）是由于慢性乙型肝炎复发，并分别
入学。中位数基准乙型肝炎病毒（HBV）DNA水平为9 × 10（5）
国际单位/毫升。十四名患者接受替诺福韦和13安慰剂。在3个月
生存的概率较高，相较于安慰剂组（8 / 14泰诺福韦
[57％]比2 / 13 [15％]，均P = 0.03）。在15死因
患者肝功能衰竭导致渐进多器官衰竭。肝
无法提供移植由于其nonavailability。在
存活下来的患者，有一个儿童，特科特显着改善
皮尤版（CTP）和终末期肝病模型（MELD评分）评分和重大
下降，乙肝病毒DNA在替诺福韦组水平，而这些参数
没有改变，在安慰剂组显着。超过2日志减少
在2周时HBV DNA的水平被认为是一个生存的独立预测因子。
结论：泰诺福韦显着降低乙肝病毒DNA水平，提高了CTP和
MELD评分，并降低患者的死亡率与严重自然
彰银重新提出作为ACLF。在HBV - DNA水平在2周减少
应该是一个理想的目标，是一个良好的生存预测。

（肝胆病2011年。）。




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