拉米用于急性自发性重症HBV治疗(2005.3.20)

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J Gastroenterol Hepatol. 2005 Mar;20(3):426-32.

Lamivudine monotherapy for spontaneous severe acute exacerbation of chronic
hepatitis B.

Tsubota A, Arase Y, Suzuki Y, Suzuki F, Sezaki H, Hosaka T, Akuta N, Someya
T, Kobayashi M, Saitoh S, Ikeda K, Kumada H.

Department of Gastroenterology, Toranomon Hospital, Minato, Tokyo, Japan.

Abstract Background: Severe acute exacerbations of chronic hepatitis B virus
(HBV) infection can spontaneously occur and rapidly progress to fatal
hepatic failure. The purpose of the present paper was to identify factors
that could influence the rapid progression of liver disease to hepatic
failure, and assess the effects of lamivudine on serious disease. Methods:
Twenty-five patients with spontaneous severe acute exacerbation (accompanied
by jaundice and coagulopathy) were consecutively treated with lamivudine.
Their clinical outcomes were compared with those of 25 lamivudine-untreated
patients, as historical controls. Results: Six lamivudine-treated patients
(24%)and seven controls (28%) rapidly developed hepatic failure. Lamivudine
monotherapy did not significantly prevent progression to hepatic failure.
Multivariate analysis identified baseline serum bilirubin >/=6 mg/dL (odds
ratio [OR]: 5.61; 95% confidence interval [CI]: 1.66-21.61; P = 0.018),
pre-existing cirrhosis (OR: 4.52; 95%CI: 1.26-30.42; P = 0.034), and
baseline prothrombin time <40% (OR: 3.75; 95%CI: 1.03-43.86; P = 0.045) as
independent determinants of the event. Of the aforementioned patients with
hepatic failure, three lamivudine-treated patients (50%) and two controls
(29%) survived (P > 0.15). However, lamivudine induced a sustained
normalization of liver function and inhibited the development of cirrhosis
in survivors. Conclusions: Lamivudine monotherapy conferred no significant
protection against rapid progression of the disease to hepatic failure, but
it resulted in long-term benefits. Lamivudine combined with other drugs
could be more beneficial for patients with the aforementioned risk factors.
(c) 2004 Blackwell Publishing Asia Pty Ltd.

PMID: 15740488 [PubMed - in process]