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目的观察替诺福韦酯(TDF)治疗HBV耐药相关的慢加急性肝功能衰竭(ACLF)患者的短期疗效。方法回顾性观察5例HBV耐药相关的ACLF患者经TDF单药或联合治疗后病毒学应答、免疫学应答情况及肝功能指标、终末期肝病模型(MELD)评分的变化。结果 5例患者接受TDF抗病毒治疗2、4周后HBV DNA复制水平均较治疗前显著下降,4例患者于8周后均达到HBV DNA<500拷贝/ml;1例患者治疗12周时HBV DNA<500拷贝/ml,该患者在治疗第8周发生HBe Ag/HBe Ab转换;4例患者主要肝功能指标及MELD评分较治疗前明显改善。结论 TDF能有效地降低ACLF患者耐药HBV DNA的复制,可能有利于提高肝功能衰竭患者的生存率。
Objective To observe the short-term efficacy of tenofovir dipivoxil (TDF) in the treatment of patients with chronic and acute liver failure (ACLF) associated with HBV resistance. Methods The changes of virological response, immunological response, liver function index and end-stage liver disease (MELD) score of five patients with ACLF associated with HBV resistance were retrospectively studied. Results After 5 and 6 weeks of treatment with TDF antiviral therapy, the level of HBV DNA replication in all 5 patients was significantly lower than that before treatment. Four patients achieved HBV DNA <500 copies / ml after 8 weeks. HBV DNA < 500 copies / ml, the patient HBeAg / HBe Ab conversion occurred in the 8th week of treatment; 4 cases of major liver function indexes and MELD score than before treatment significantly improved. Conclusion TDF can effectively reduce the replication of resistant HBV DNA in patients with ACLF, which may be beneficial to improve the survival rate of patients with liver failure.