| Objective:1.To study on the differences in the prognosis of acute-on-chronic liver failure patients caused by withdrawal nucleos(t)ide analogs in patients with HBeAg positive and HBeAg negative chronic hepatitis B.2.To explore the possible reasons of the differences in the outcome of acute-on-chronic liver failure caused by withdrawal nucleos(t)ide analogs due to HBeAg status.3.To analyze the factors influencing the prognosis of acute-on-chronic liver failure patients caused by withdrawal of nucleos(t)ide analogs.Methods:1.Using retrospective analysis method,according to the diagnosis standard of 2018 diagnosis and treatment guidelines for liver failure,108 patients with relapse and acute-on-chronic hepatitis B liver failure after discontinuation of nucleos(t)ide analogs who were admitted to the First Affiliated Hospital of Nanchang University from January 2017 to December 2018 were collected as research objects,and the clinical data of patients were recorded.To analyze the differences in the outcome of chronic hepatitis B patients with HBeAg positive and HBeAg negative after discontinuation of nucleos(t)ide analogs.To analyze the factors that influencing the prognosis of chronic hepatitis B patients after discontinuation of nucleoside(acid)drugs.2.Forty cases of chronic hepatitis B patients treated with long-term nucleos(t)ide analogs from our clinic in 2005-2019 were collected.The diagnostic criteria were in line with the Chinese guidelines for the prevention and treatment of chronic hepatitis B in 2015.The patients were divided into two groups according to HBeAg:(1)HBeAg positive group: 20 cases;(2)HBeAg negative group: 20 cases.To analyze and compare the changes of serum HBV pgRNA in patients with HBeAg positive and HBeAg negative.Results:1.Among 108 acute-on-chronic liver failure who stopped drug and relapsed,the improvement rate of HBeAg positive group was 49.1%,the deterioration rate was 50.9%,the improvement rate of HBeAg negative group was 74.5%,and the deterioration rate was 25.5%.The improvement rate of HBeAg negative group was higher than that of HBeAg positive group(P < 0.05).The level of HBV DNA in HBeAg positive group was higher than that in HBeAg negative group(P < 0.05)2.In 40 patients with chronic hepatitis B treated with long-term nucleotide analogues,the detection rate of HBV pgRNA was 95% in HBeAg positive group,75% in HBeAg negative group,and the detection rate of HBV pgRNA in HBeAg positive group is higher than that in HBeAg negative group.The difference was not statistically significant in two groups(P > 0.05).The median value of HBV pgRNA in HBeAg positive group was 2995 copies / ml,which was higher than that in HBeAg negative group,which was 114.45 copies / ml,and the difference was statistically significant(P < 0.05).3.The statistical analysis showed that the average age,HBeAg positive rate,HBV DNA level,total bilirubin,direct bilirubin,prothrombin time,activated partial prothrombin time and international standardization rate of the patients in the death / deterioration group were higher than those in the survival / improvement group,and the differences between the above indexes were statistically significant(P < 0.05).There was no significant difference between the two groups in gender,cirrhosis,drinking history,antiviral treatment course,time from drug withdrawal to recurrence,HBeAg titer,HBeAb titer,HBcAb titer,ALT,AST,and pedestrian liver treatment(P > 0.05).Through logistic regression analysis,it is suggested that the elderly and the increase of APTT are independent risk factors for the short-term adverse prognosis of patients with chronic and acute liver failure caused by withdrawal of nucleoside drugs.Conclusion:1.The clinical improvement rate of HBeAg negative group was higher than that of HBeAg positive group.The HBV DNA level of HBeAg negative group was lower than that of HBeAg positive group on admission,suggesting that HBeAg was positively correlated with HBV DNA level.2.The level of HBV pgRNA in HBeAg positive group was higher than that in HBeAg negative group,suggesting that there was a certain correlation between HBeAg and HBV pgRNA.3.Age increasing and high level of APTT are the independent risk factors for short-term prognosis of acute-on-chronic liver failure patients caused by withdrawal of NAs. |
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