乙型肝炎肝硬化和慢加急性肝衰竭患者并发感染影响因素与预后分析*

doi:10.3969/j.issn.1672-5069.2024.06.023

摘要/Abstract

摘要： 目的探讨乙型肝炎病毒(HBV)相关肝硬化(LC)和慢加急性肝衰竭(HBV-ACLF)患者并发感染及其对预后的影响。方法回顾性分析我科过去8年收治的323例乙型肝炎LC、124例ACLF A型和184例ACLF B型患者的临床资料,应用二分类Logistics回归分析并发感染的危险因素并绘制ROC曲线,采用Kaplan-Meier法行生存分析,组间比较采用Log-rank检验。结果 LC组、ACLF A型组和ACLF B型组感染发生率分别为31.0%、32.1%和44.0%,以自发性细菌性腹膜炎为最多见;将三组合并,感染组患者年龄大,血清白蛋白水平低,血清总胆红素和凝血酶原时间国际标准化比值高,并发肝性脑病和消化道出血比例高(P＜0.05),Logistics回归分析显示年龄、血清总胆红素水平和并发消化道出血是并发感染的独立危险因素,而血清白蛋白水平是保护因素;LC组并发感染患者病死率为16.0%,与未感染患者的15.2%比,无显著性差异(P>0.05),而ACLF A型并发感染患者病死率为57.5%,ACLF B型并发感染患者为65.4%,均显著高于未感染患者(分别为14.3%和27.2%,P＜0.05);生存曲线分析显示,HBV-ACLF A型无感染患者生存率是感染者的5.713倍,HBV-ACLF B型无感染患者生存率是感染者的3.364倍。结论乙型肝炎导致的LC和HBV-ACLF患者并发感染的风险较高,控制风险因素,降低感染发生率可能能改善预后。

关键词: 肝硬化, 慢加急性肝衰竭, 感染, 影响因素, 预后

Abstract: Objective The aim of this study was to investigate influencing factors of infections in patients with hepatitis B-induced liver cirrhosis (LC) and acute-on-chronic liver failure (ACLF). Methods 323 patients with hepatitis B-induced LC, 124 patients with ACLF type A (with underlying chronic hepatitis B) and 184 patients with ACLF type B (with underlying compensated LC) were encountered in our hospital during last eight years. Multivariate Logistics regression analysis was applied for influencing factors of infections, and Kaplan-Meier curves were used for 90-day survival analysis. Results Incidences of infections in patients with LC, with ACLF type A and ACLF type B were 31.0%, 32.1% and 44.0%, with spontaneous bacterial peritonitis more common; age older, serum albumin level decreased, total serum bilirubin (TSB) level and prothrombin time international standardized ratio increased, incidence of hepatic encephalopathy and gastrointestinal hemorrhage (GIH) increased in patients with infections no matter in which groups(P＜0.05); Logistics regression analysis showed that age, TSB, and GIH were all the independent risk factors for infections, while serum albumin level was a protective one; fatality rate in patients with LC was 16.0%, not significantly different compared to 15.2% in those without infection(P>0.05), while they were 57.5% in those with ACLF type A and 65.4% in with ACLF type B, both significantly higher than 14.3% and 27.2% (P＜0.05) in patients without infections; survival curve analysis showed that survival rate in HBV-ACLF type A patients without infection was 5.713 times higher than in patients with infection, and survival rate in HBV-ACLF type B patients without infection was 3.364 times higher than in those with infection. Conclusion Patients with HBV-induce LC and ACLF have higher risk of infection, and we should take risk factors into consideration in clinical practice, which might improve outcomes of them.

Key words: Liver cirrhosis, Acute-on-chronic liver failure, Infection, Influencing factors, Prognosis

董旭, 秦阳华, 廖威, 许明晓, 葛玲玲, 李成忠. 乙型肝炎肝硬化和慢加急性肝衰竭患者并发感染影响因素与预后分析^*[J]. 实用肝脏病杂志, 2024, 27(6): 891-894.

Dong Xu, Qin Yanghua, Liao Wei, et al. Influencing factors of infections in patients with hepatitis B-induced liver cirrhosis and acute-on-chronic liver failure[J]. Journal of Practical Hepatology, 2024, 27(6): 891-894.

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乙型肝炎肝硬化和慢加急性肝衰竭患者并发感染影响因素与预后分析^*

Influencing factors of infections in patients with hepatitis B-induced liver cirrhosis and acute-on-chronic liver failure

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