Investigating The Application And Survival Analysis Of Nucleoside And Nucleoside Analogs In The Treatment Of Chronic Severe Hepatitis B

Objective:In this paper, the author tries to explore the treatment effects of CSHB(Chronic Severe Hepatitis B) with NUCs(Nucleoside and Nucleoside Analogs) and the factors affecting the survival rate and prognosis of CSHB. Methods:976 CSHB patients hospitalized from January, 2001 to December, 2009 were selected in the present research and they were all given comprehensive internal medical treatment. Based on treatment methods, they were divided into NUCs group(experimental group) and non-NUCs group(control group). Propensity score calipers matching was employed to match the CSHB patients in the groups. Covariate equilibrium samples were then obtained. Based on the new samples, the survival analysis was made, the treatment effects of CSHB with NUCs were explored and the factors affecting CSHB prognosis were analyzed. Then Dummy Variable Regression Model was employed to compare the short-term anti-viral treatment effects with LAM(lamivudine), ETV(entecavir) and the combined administration of LAM and ADV(adefovir dipivoxil) respectively. Results:By employing propensity score matching, 262 pairs were matched successfully, and the differences among the indicators of the two baselines were not statistically significant(P>0.05). Long-term survival rate and survival time in NUCs group was greater than that of control group, and the differences were statistically significant(P<0.05). Multivariate analysis showed that all the following factors are independent prognostic factors that would affect patients’ long-term survival rate: gender, age, MELD value, cholinesterase, white cell, hepatic encephalopathy, infection and the application of NUCs. Multivariate regression analysis showed that CSHB patients’ short-term prognosis was affected respectively by(from the major one to minor one): MELD value, age, neutrophilic granulocyte percentage, the grading of hepatic encephalopathy, the application of NUCs, HBV DNA level, the times of artificial liver plasma exchange treatment, cholinesterase and total bilirubin(TBil)(P<0.05). It was also found that there was no significant difference among the treating effects of CSHB short-term prognosis with LAM, ETV and the combined administration of LAM and ADV. Conclusion:Treating CSHB with NUCs could improve patients’ prognosis and reduce case-fatality. Independent prognostic factors such as gender, age, MELD value, cholinesterase, white cell, hepatic encephalopathy, infection and the application of NUCs could affect patients’ long-term survival rate. NUCs anti-viral treatment and the times of artificial liver plasma exchange treatment were favorable factors for CSHB short-term prognosis, while the following ones were negative for CSHB short-term prognosis, such as high MELD value, advanced age, high neutrophilic granulocyte percentage, high level of hepatic encephalopathy, high HBV DNA level, high total bilirubin(TBil) and low cholinesterase. Besides, there was no statistically significant difference among the treating effects of CSHB short-term prognosis with LAM, ETV and the combined administration of LAM and ADV.