Objective: To analyze the occurrence of recompensation conditions in patients with chronic hepatitis B virus-related decompensated cirrhosis after entecavir antiviral therapy. Methods: Patients with hepatitis B virus-related decompensated cirrhosis with ascites as the initial manifestation were prospectively enrolled. Patients who received entecavir treatment for 120 weeks and were followed up every 24 weeks (including clinical endpoint events, hematological and imaging indicators, and others) were calculated for recompensation rates according to the Baveno VII criteria. Measurement data were compared using the Student t-test or Mann-Whitney U test between groups. Categorical data were compared by the χ (2) test or Fisher's exact probability method between groups. Results: 283 of the 320 enrolled cases completed the 120-week follow-up, and 92.2% (261/283) achieved a virological response (HBV DNA 20 IU/ml). Child-Pugh and MELD scores were significantly improved after treatment (8.33 ± 1.90 vs. 5.77 ± 1.37, t = 12.70, P < 0.001; 13.37 ± 4.44 vs. 10.45 ± 4.58, t = 5.963, P < 0.001). During the 120-week follow-up period, 14 cases died, two received liver transplants, 19 developed hepatocellular cancer, 11 developed gastroesophageal variceal bleeding, and four developed hepatic encephalopathy. 60.4% (171/283) (no decompensation events occurred for 12 months) and 56.2% (159/283) (no decompensation events occurred for 12 months and improved liver function) of the patients had achieved clinical recompensation within 120 weeks. Patients with baseline MELD scores > 15 after active antiviral therapy achieved higher recompensation than patients with baseline MELD scores ≤15 [50/74 (67.6%) vs. 109/209 (52.2%), χ (2) = 5.275, P = 0.029]. Conclusion: Antiviral therapy can significantly improve the prognosis of patients with hepatitis B virus-related decompensated cirrhosis. The majority of patients (56.2%) had achieved recompensation. Patients with severe disease did not have a lower probability of recompensation at baseline than other patients.
目的： 分析恩替卡韦抗病毒治疗后慢性乙型肝炎失代偿期肝硬化患者再代偿的发生情况。 方法： 前瞻性纳入以腹水为首发表现的慢性乙型肝炎失代偿期肝硬化患者，接受恩替卡韦治疗120周，每24周对患者进行1次随访（包括临床终点事件、血液学及影像学指标等），根据Baveno VII标准计算再代偿率。计量资料组间比较采用Student t检验或Mann-whitney U检验；计数资料的组间比较采用χ(2)检验或Fisher确切概率法。 结果： 在入组的320例患者中，283例完成了120周的随访，其中92.2%（261/283）的患者实现了病毒学应答。（HBV DNA < 20 IU/ml），治疗后患者的Child-Pugh评分和MELD评分明显改善[（8.33±1.90）分与（5.77±1.37）分，t = 12.70，P < 0.001; （13.37±4.44）分与（10.45±4.58）分，t = 5.963, P < 0.001)。在120周随访期间，14例患者死亡，2例接受肝移植，19例发展为肝细胞癌，11例发生食管胃底静脉曲张出血，4例发生肝性脑病；60.4% （171/283）的患者在120周内实现了临床再代偿（持续12个月未发生失代偿事件），56.2%（159/283）的患者实现了再代偿（持续12个月未发生失代偿事件且肝功能好转）；基线MELD评分> 15的患者积极抗病毒治疗后实现再代偿的概率高于基线MELD评分≤15的患者[67.6%（50/74）与52.2%（109/209），χ(2) = 5.275，P = 0.029]。 结论： 乙型肝炎失代偿期肝硬化患者抗病毒治疗可以显著改善预后，大部分患者（56.2%）可以实现再代偿，基线病情较重的患者实现再代偿的概率并不低于其他患者。.
Keywords: Chronic hepatitis B; Decompensated cirrhosis; Recompensation.