Abstract：
Major causes of acute insult in Hepatitis B virus related acute on chronic liver failure in the Asian region are reactivation of Hepatitis B virus and super infection with hepatitis A and E virus (ACLF). Anti viral therapy should be started as soon as possible in the ACLF patients at presentation while waiting for confirmation by HBV DNA level. This randomized controlled trial was carried out at the Department of Hepatology, BSMMU, Bangladesh from September 2019 to august 2020 with Hepatitis B virus related ACLF patient. This trial was conducted among twenty seven HBV acute on chronic liver failure patient to compare Child Turcotte pugh (CTP) score, Model for end stage liver disease (MELD) score, Asia Pacific Association for study of Liver (APASL) ACLF Research consortium (AARC) score, survival of the patients and HBV DNA level at 3 months with antiviral therapy between tenofovir alafenamide (25mg) and entecavir (0.5mg) group. CTP score, MELD score and AARC score were significantly (p<0.05) decline from baseline to all subsequent follow-up at 1st (at 7 days), 2nd (at 14 days), 3rd (at 30 days) and 4th (at 90 days) in each group but non significant (p>0.05) difference occurred between two group. All twenty seven patients had detectable HBV DNA level at pre-treatment and all survived patients became undectable at 4th, 90 days follow-up. Total 10 patients (37.07%) were survived at 90 days follow-up, out of them seven patients (70.0%) were in tenofovir alafenamide group and three patients (30.0%) were in entecavir group which was statistically significant (p<0.05) in between two group. Hepatic encephalopathy and hepatorenal syndrome were most common causes of death in both groups. Both drugs tenofovir alafenamide and entecavir significantly improves liver functions but the former one is superior regarding survival.
摘要：
在亚洲地区，乙型肝炎病毒相关的急性慢性肝衰竭急性损伤的主要原因是乙型肝炎病毒的再激活和甲肝和戊肝病毒的超级感染（ACLF）。在等待HBVDNA水平确认时，应尽快在ACLF患者中开始抗病毒治疗。这项随机对照试验在肝病科进行，BSMMU,孟加拉国从2019年9月至2020年8月与乙型肝炎病毒相关的ACLF患者。这项试验是在27例HBV急性慢性肝衰竭患者中进行的，以比较ChildTurcottepugh（CTP）评分，终末期肝病模型（MELD）评分，亚太肝脏研究协会（APASL）ACLF研究联盟（AARC）评分，替诺福韦艾拉酚胺（25mg）和恩替卡韦（0.5mg）组之间抗病毒治疗3个月时患者的生存率和HBVDNA水平。CTP评分,在第1天（第7天），MELD评分和AARC评分从基线到所有后续随访均显着（p<0.05）下降，第二（14天），第3(30天)和第4(90天)两组间差异无统计学意义(p>0.05)。所有27名患者在治疗前都有可检测到的HBVDNA水平，所有存活的患者在第4位变得无法察觉，90天随访。随访90天存活10例(37.07%),其中替诺福韦组7例(70.0%)，恩替卡韦组3例(30.0%)，两组间有统计学意义(p<0.05)。肝性脑病和肝肾综合征是两组中最常见的死亡原因。两种药物替诺福韦艾拉酚胺和恩替卡韦显著改善肝功能，但前者是优越的生存。
