慢加急性/亚急性乙型肝炎肝衰竭患者发病诱因及影响临床转归因素分析*

doi:10.3969/j.issn.1672-5069.2022.06.019

摘要/Abstract

摘要： 目的分析乙型肝炎相关性慢加急性(亚急性)肝衰竭(HBV-ACLF)患者发病诱因和影响临床转归的因素。方法 2019年1月～2021年12月我科收治的96例HBV-ACLF患者,接受内科综合治疗,观察90 d生存情况。应用单因素和多因素Logistic回归分析影响HBV-ACLF患者临床转归的因素。结果本组HBV-ACLF患者发病诱因包括自行停用核苷(酸)类药物53例(55.2%)、并发HAV或HEV感染11例(11.4%)、并发细菌感染9例(9.4%)、劳累7例(7.3%)、饮酒6例(6.2%)、药物性肝损害5例(5.2%)和原因不明5例(5.2%);在治疗观察90 d,生存69例,死亡27例;死亡患者年龄为50(41,69)岁,显著大于生存患者【39(33,58),P<0.05】,并发消化道出血、肝性脑病和急性肾损伤的比率分别为14.8%、29.6%和44.4%,显著高于生存患者(分别为1.4%、5.8%和14.5%,P<0.05),血清总胆红素水平为532(204,780)μmol/L,显著高于生存组【302(80,416)μmol/L,P<0.05】,INR为3.0(2.0,3.4),显著大于生存患者【2.1(1.5,2.6),P<0.05】,MELD评分为26(18,37),显著大于生存患者【20(10,29),P<0.05】;多因素Logistic回归分析结果显示年龄【OR=1.04(95%CI:1.02～1.08)】、并发消化道出血【OR=1.51(95%CI:1.23～0.79)】、肝性脑病【OR=0.50(95%CI:0.22～0.78)】、INR【OR=1.52(95%CI:1.22～0.73)】和MELD评分【OR=2.44(95%CI:1.63～3.75)】均是影响HBV-ACLF患者死亡发生的独立危险因素。结论熟知诱发HBV-ACLF患者发病的诱因有助于做好防治工作,而针对能引起患者死亡的因素做好临床救治可能提高肝衰竭患者生存率,临床和社会意义重大。

关键词: 慢加急性肝衰竭, 乙型肝炎, 诱因, 预后, 影响因素

Abstract: Objective The aim of this study was to analyze the triggering factors and impacting factors of prognosis in patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF). Methods A retrospective analysis was performed on 96 patients with HBV-ACLF between January 2019 and December 2021, and all patients received comprehensive internal medicine supporting therapy at base of entevavir antiviral treatment. The patients were followed-up for 90 days. The univariate and multivariate Logistic regression analysis were applied to reveal the risk factors that impacted the prognosis. Results The triggering factors in our series included self-discontinuation of antiviral therapy in 53 cases (55.2%), hepatitis H or hepatitis E co-infection in 11 cases (11.4%), complicated bacterium infection in 9 cases (9.4%), exhausted in 7 case (7.3%), binge in 6 case (6.2%), drug-induced liver injuries in 5 cases (5.2%) and cryptogenic in 5 cases (5.2%); at the end of 90 day observation, 69 patients survived and 27 patients died; the median ages in dead patients was 50(41, 69)yr, significantly older than [39(33, 58) yr, P<0.05] in survived patients, the incidences of complication, such as gastrointestinal bleeding (GIB), hepatic encephalapathy (HE) and acute kidney injury (AKI), were 14.8%, 29.6% and 44.4%, significantly higher than 1.4%, 5.8% and 14.5% (P<0.05) in the survivals, and serum bilirubin level was 532(204, 780)μmol/L, significantly higher than [302(80, 416)μmol/L, P<0.05], the INR was 3.0(2.0, 3.4), significantly higher than [2.1(1.5, 2.6), P<0.05] and the MELD score was 26(18, 37), significantly higher than [20(10, 29), P<0.05] in the survivals; the multivariate Logistic regression analysis showed that the ages [OR=1.04(95%CI:1.02-1.08)], GIB[OR=1.51(95%CI:1.23-0.79)], HE [OR=0.50(95%CI:0.22-0.78)], INR[OR=1.52(95%CI:1.22-0.73)] and the MELD score [OR=2.44(95%CI:1.63-3.75)] were the independent risk factors for poor prognosis in patients with HBV-ACLF. Conclusion The predisposing factors of patients with HBV-ACLF mainly include inappropriate discontinuation of nucleos(t)ide , other heparnavirus infections and bacterial infections. The clinicians should take the risk factors ,such as elderly age, GIB, HE, and MELD scores into consideration and deal with them carefully to improve the prognosis.

Key words: Acute-on-chronic liver failure, Hepatitis B, Predisposing causes, Prognosis, Risk factors

李荣, 曹晶晶, 李晶, 潘峰. 慢加急性/亚急性乙型肝炎肝衰竭患者发病诱因及影响临床转归因素分析^*[J]. 实用肝脏病杂志, 2022, 25(6): 832-835.

Li Rong, Cao Jingjing, Li Jing, et al.. Triggering and impacting factors of prognosis in patients with hepatitis B virus-associated acute-on-chronic liver failure[J]. Journal of Practical Hepatology, 2022, 25(6): 832-835.

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慢加急性/亚急性乙型肝炎肝衰竭患者发病诱因及影响临床转归因素分析^*

Triggering and impacting factors of prognosis in patients with hepatitis B virus-associated acute-on-chronic liver failure

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