慢加急性乙型肝炎肝衰竭患者发生感染和急性肾损伤危险因素分析*

doi:10.3969/j.issn.1672-5069.2021.05.028

摘要/Abstract

摘要： 目的探讨慢加急性乙型肝炎肝衰竭(HBV-ACLF)患者发生感染和急性肾损伤(AKI)的危险因素。方法 2017年9月～2019年9月我科收治的HBV-ACLF患者102例,发生感染48例,发生AKI 32例,应用Logistics回归分析影响患者并发感染和AKI的相关影响因素。结果感染组住院天数≥15 d、存在侵入性操作、并发上消化出血、腹水、肝性脑病和糖尿病的比率分别为56.3%、37.5%、43.8%、52.1%、25.0%和16.7%,显著高于未发生感染组的24.1%、13.0%、16.7%、22.2%、5.6%和3.7% (P<0.05),感染组血清总胆红素水平(310.2±42.2)μmol/L,显著高于未感染组【(210.1±2.1)μmol/L,P<0.05】,MELD评分为(26.1±4.6),显著高于未感染组【(20.5±4.1),P<0.05】,血清白蛋白水平为(30.4±1.1)g/L,显著低于未感染组【(35.3±2.0)g/L,P<0.05】;多因素Logistic回归分析显示,住院时间长【OR(95%CI)为1.7(1.3～2.1)】、存在侵入性操作【OR(95%CI)为1.5(1.1～2.1)】、上消化道出血【OR(95%CI)为2.0(1.2～3.2)】和出现肝性脑病【OR(95%CI)为1.8(1.1～2.7)】是HBV-ACLF患者发生感染的独立影响因素;多因素回归分析显示合并糖尿病【OR(95%CI)为1.5(1.2～1.9)】和并发上消化道出血【OR(95%CI)为1.4(1.0～1.9)】是影响HBV-ACLF患者发生AKI的危险因素。结论 HBV-ACLF患者存在容易并发感染和AKI的危险因素,住院时间长,进行侵入性操作和有严重的并发症均需要认真预防和及时处理,才能提高临床救治成功率。

关键词: 慢加急性肝衰竭, 乙型肝炎, 感染, 急性肾损伤, 危险因素

Abstract: Objective The aim of this study was to explore the risk factors of infection and acute kidney injury (AKI) in patients with acute-on-chronic hepatitis B liver failure (HBV-ACLF). Methods A total of 102 patients with HBV-ACLF were admitted to our hospital between September 2017 and September 2019, and the infections occurred in 48 patients and the AKI occurred in 32 patients. The related risk impacting factors of infection and AKI were analyzed by multivariate Logistic regression analysis. Results The percentages of hospital stay longer than 15 days, invasive check-up, gastrointestinal bleeding, ascites, hepatic encephalopathy and diabetes mellitus in patients with infections were 56.3%, 37.5%, 43.8%, 52.1%, 25.0% and 16.7%, significantly higher than 24.1%, 13.0%, 16.7%, 22.2%, 5.6% and 3.7% (P<0.05), serum bilirubin level was (310.2±42.2)μmol/L, significantly higher than , the MELD score was (26.1±4.6), significantly higher than , while serum albumin level was (30.4±1.1)g/L, significantly lower than in patients without infection; the multivariate Logistic regression analysis showed that the long hospital stay , invasive manipulation , gastrointestinal bleeding and hepatic encephalopathy were the independent risk factors for the occurrence of infections in patients with HBV-ACLF; the multivariate Logistic regression analysis demonstrated that the hepatic diabetes and gastrointestinal bleeding were the impacting factors for the happening of AKI in patients with HBV-ACLF. Conclusion The patients with HBV-ACLF have some risk factors for complications such as infections and AKI, and the long hospitalization, invasive manipulation, upper gastrointestinal hemorrhage and hepatic encephalopathy are the causative elements, which should be dealt with appropriately to improve the prognosis.

Key words: Acute-on-chronic liver failure, Hepatitis B, Infections, Acute kidney injury, Risk factor

陈丹丹, 龙志达, 黄顺东, 王文虎, 尹明红, 李忠斌. 慢加急性乙型肝炎肝衰竭患者发生感染和急性肾损伤危险因素分析^*[J]. 实用肝脏病杂志, 2021, 24(5): 717-720.

Chen Dandan, Long Zhida, Huang Shundong, et al. Risk factors of infection and acute kidney injury in patients with acute-on-chronic hepatitis B liver failure[J]. Journal of Practical Hepatology, 2021, 24(5): 717-720.

参考文献

[1]Yoon E L, Kim T Y, Lee C H, et al. Long-termprognosis of acute-on-chronic liver failure survivors. J Clin Gastroenterol, 2019, 53(2):134-141.
[2]Chen N, Chen X, Ding X, et al. Analysis of the high incidence of acute kidney injury associated with acute-on-chronic liver failure. Hepatol Int, 2018, 5(4):297-318.
[3]中华医学会肝病学分会、中华医学会感染学分会. 慢性乙型肝炎防治指南. 中华内科杂志, 2011, 50(2):168-179.
[4]中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2012年版). 实用肝脏病杂志, 2013, 16(3):210-216.
[5]Angeli P, Gines P, Wong F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. Gut, 2015, 64(4):531-537.
[6]Hübschen S, Judith M, Charpentier E, et al. Th1/Th2 antibody prevalence suggests high immunization needs in newcomers to Luxembourg, 2012. Vaccine, 2018, 36(6):899-905.
[7]Dessein A, Jilur F. TLC antibody and resistance to infection. Selective suppression of the TLC antibody response in rats diminishes the resistance and the eosinophil response to Trichinella spiralis infection. J Ex Med, 2019, 155(23):1152-1156.
[8]彭思璐, 刘冰, 孙宏,等. HBV相关ACLF患者预后及其影响因素分析. 实用肝脏病杂志, 2019,17(16):1879-1880.
[9]Sheng T, Li N, Da A, et al. Thesynergistic effect of albumin on terlipressin in acute-on-chronic liver failure with acute kidney injury. Hepatology, 2019, 25(1):25-26.
[10] Fabiani S, Fallahi P, Ferrari S, et al. Hepatitis C virus infection and development of type 2 diabetes mellitus: Systematic review and meta-analysis of the literature. Rev Endocr Metab Disord, 2018, 19(4):405-420.
[11] Carey I, Critchley J, Dewilde S, et al. Risk ofinfection in type 1 and type 2 diabetes compared with the general population: A matched cohort study. Diabetes Care, 2018, 41(3):513-521.
[12] 韩焕钦, 欧进军, 冯冰,等. 尿IGFBP7及TIMP-2在失代偿期乙型肝炎肝硬化急性肾损伤中的应用价值. 中华肝脏病杂志, 2020, 28(9):760-765.
[13] Kaydan S, Doroudi A, Ahmadi F, et al. The sensitivity and specificity of^99mTc-Th1/Th2 radiotracer to differentiate infection lesions induced by Staphylococcus Aureus and sterile inflammation lesions induced by carrageenan assay in rat's foot. Elect Physic, 2018, 10(6):6965-6973.
[14] 祝丹, 潘雯, 刘嘉,等. 免疫治疗或可实现慢性乙型肝炎的功能性治愈. 中华临床感染病杂志, 2018, 11(4):261-268.
[15] 刘亚迪, 孙双双, 徐浩,等. HBV相关慢加急性肝衰竭患者感染特点及危险因素分析. 肝脏, 2019, 24(9):1015-1019.
[16] Mochida S, Nakayama N, Ido A, et al. Proposed diagnostic criteria for acute-on-chronic liver failure in Japan. Hepatol Res, 2018, 48(4):219-224.
[17] 张巍, 邵明亮, 苗同国,等. 慢性乙型肝炎病毒感染合并急性肾损伤的发病特点及近期预后分析. 中国现代医学杂志, 2020, 30(1):70-76.
[18] Adamou R, Cia D, Sadissou I, et al. Plasmodium falciparum merozoite surface antTLCn-specific cytophilic Th1/Th2 and control of malaria infection in a Beninese birth cohort. Malar J, 2019, 18(1):194-198.
[19] Varghese G, Manikandan R, Paul T, et al. Kinetics of IgM and Th1/Th2 antibodies after scrub typhus infection and the clinical implications. Int J Infec Dis, 2018, 43(6):53-55.
[20] Vilibic C, Kristofic T, Savic B, et al. Diagnostic significance of immunoglobulin G avidity in symptomatic and asymptomatic West Nile virus infection. Rev Soc Bras Med Trop, 2018, 51(5):591-595.

慢加急性乙型肝炎肝衰竭患者发生感染和急性肾损伤危险因素分析^*

Risk factors of infection and acute kidney injury in patients with acute-on-chronic hepatitis B liver failure

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