Translated Abstract
Background:
Hepatitis B virus infection is the main cause of liver cirrhosis in our country, it is a major risk factor for liver cirrhosis, liver failure and hepatocellular carcinoma. The increase of intrahepatic vascular resistance and portal venous system blood flow in cirrhosis can lead to the formation of portal hypertension. Esophagogastric varices is the consequence of portosystemic venous collaterals openning which caused by portal hypertension. Esophagogastric variceal haemorrhage is considered to be an important complication of portal hypertension, as it can be massive, the first bleeding mortality rate was up to 15%-20%, so it is a serious threat to the patients. Nucleoside antiviral drugs can rapidly inhibit virus replication, reduce the inflammation of the liver, improve liver function, ameliorate liver fibrosis, prevent disease progression, delay and reduce the occurrence of cirrhosis and hepatocellular carcinoma, reduce the mortality rate. But the research about the nucleoside antiviral drugs whether it can reverse liver fibrosis, reverse cirrhosis, decrease the pressure of portalveins, relieve the degree of esophageal varices was still less at home and abroad.
Objective:
This study is a retrospective study, aims to explore the effects of nucleoside antiviral drugs on liver function, HBV-DNA, coagulation function, the degree of esophageal varices, canceration rate, mortality , bleeding rate ,the occurrence and response rate of ascites in patients with HBV-related cirrhosis and portal hypertension, hereby, to provide some reference for the clinical treatment of HBV-related cirrhosis and portal hypertension
Methods:
88 patients with HBV-related cirrhosis and portal hypertension were included at the second affiliated hospital of Medical School of Xi’an Jiaotong University from Jan1,2010 to Dec31, 2014. Among them, 55 patients belongs to the treatment group and were treated with nucleostide analogues, 33 patients belongs to control group and were treated with liver protecting drugs. Recording the change of clinical and endscopic after treatment. Compared and analyzed the differences of total bilirubin(TBIL), alanine aminotransferase(ALT), aspartate aminotransferase(AST), albumin(ALB), prothrombin time(PT), prothrombin activity(PTA), Child-Pugh score, HBV-DNA, esophagus varicosity degree, cancer rate, mortality , bleeding rate ,the occurrence and response rate of ascites .
Results:
Compared TBIL, ALT, AST, ALB, PT, PTA, Child-Pugh score in treatment group before and after treatment, the difference had statistical significance(P＜0.05); There were no significant differences in TBIL, ALT, PT, PTA, Child-Pugh score before and after treatment in the control group(P＞0.05), but compared AST and ALB, the difference in the control group has statistical significance(P＜0.05); After treatment, TBIL, ALT, AST, ALB, PT, PTA in the two groups has no significant difference(P＞0.05), the difference of Child-Pugh score in the two groups has statistical significance(P＜0.05).
HBV-DNA test in the treatment group were all positive, and 19 patients in the control group were negative, before treatment, and, after treatment,43 patients in the treatment group were negative,12 patients in the treatment group were positive but all were lower than before treatment; 1 patient in the control group became negative who was positive before, 3 patients in the control group became positive who were negative before, 7 patients in the control group were lower than before, 15 patients in the control group were higher than before; the HBV-DNA negative turning rate in the two groups the difference had statistical significance(P＜0.05).
There were 28 patients had not received EVL in the treatment group, and 7 patients had not received EVL in the control group, the inter-class comparison shows that the difference has statistical significance(P＜0.05). Compare the patients who had not received EVL, there were 12 patients with esophageal varices relieved and 4 patients with esophageal varices aggravated in the treatment group.There were 4 patients with esophageal varices aggravated in the control group, no patient in the control group relieved. It has statistical significance between the two groups ( P ＜ 0.05); 12 patients who were relieved included 8 patients with light degree varices before treatment and 4 patients with moderate before treatment, no case was sever before, it has statistical significance between the differences( P ＜ 0.05)
There were 6 patient became cancerous and 2 patients died in the treatment group, 2 patients died and no patient became cancerous in the control group, the difference between the two groups has no statistical significant(P＞0.05)
Compared ascites patients, there was no significant difference between the two groups before and after treatment (P ＞ 0.05), extinction and appearance of ascites has no significant difference between two groups after treatment (P ＞ 0.05); there were 16 patients occured hematemesis and melena in the treatment group, and 24 patients in the control group, there has significant difference in the two groups ( P ＜ 0.05).
Conclusions:
Antiviral therapy can rapidly inhibit the replication of HBV-DNA, reduce TBIL, ALT, AST, PT levels, increases ALB, PTA levels, lowers Child-Pugh score and improve liver function.
Antiviral therapy can reduce the mild and moderate degree of esophageal varices, but have no significant effect on the severe esophageal varices;
Antiviral therapy had no significant effect on the cancer rate, mortality and the occurrence and response rate of ascites.
Antiviral therapy can reduce the rate of bleeding in patients with hepatitis B cirrhosis.
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