HBV相关慢加急性肝衰竭患者预后及其影响因素分析*

doi:10.3969/j.issn.1672-5069.2019.04.024

摘要/Abstract

摘要： 目的探讨影响乙型肝炎相关性慢加急性肝衰竭（ACLF）患者预后的因素。方法 2014年5月~2017年5月我院诊治的ACLF患者120例,给予内科综合治疗和人工肝治疗,回顾性分析其临床资料,应用二元多因素Logistic回归分析影响预后的因素。结果经过3~6个月治疗,本组患者生存52例（43.3%）,死亡68例（56.7%）;两组患者性别、发病前病程、长期抗病毒和是否接受人工肝治疗等方面无显著性差异（P>0.05）,但生存组年龄≥50岁的比例和并发症发生率分别为40.4%和46.1%,均显著低于死亡组的61.8%和79.4%（P<0.05）;两组血清PAB、TBA、BUN、Cr和HBV DNA水平差异无显著性统计学意义（P>0.05）,但生存组患者血清TBIL和PT水平显著低于死亡组（P<0.05）,血清Alb、CHE、TC和AFP水平显著高于死亡组（P<0.05）;生存组肝性脑病、肝肾综合征、电解质紊乱和多种并发症发生率分别为7.7%、1.9%、15.4%和11.5%,显著低于死亡组的45.6%、14.7%、39.7%和26.5%（P<0.05）,而两组上消化道出血和自发性细菌性腹膜炎发生率比较,无显著性差异（P>0.05）;将血清TBIL、Alb、CHE、PT、TC、AFP、年龄和并发症作为自变量,预后结果作为应变量,经二元多因素Logistic回归分析发现,年龄、PT、肝性脑病、电解质紊乱和并发症发生是HBV相关的ACLF患者预后的独立影响因素。结论了解影响乙型肝炎导致的ACLF患者预后的因素,做到早诊断,早治疗,把好可能导致死亡因素的治疗关,积极防治各种并发症,才能提高救治ACLF患者的成功率。

关键词: 慢加急性肝衰竭, 慢性乙型肝炎, 预后, 影响因素

Abstract: Objective To investigate the factors impacting the prognosis of patients with hepatitis B-induced acute-on-chronic liver failure（ACLF）.Methods 120 patients with hepatitis B-induced ACLF were admitted to our hospital between May 2014 and May 2017,and the clinical materials of all patients were retrospectively analyzed. All patients received conventional comprehensive medical treatments. The factors affecting prognosis was found by binary multivariate Logistic analysis.Results At the end of three to six month treatment,52 patients with ACLF（43.3%） survived and 68（56.7%） dies;at presentation, the gender,disease period,anti-viral therapy and artificial liver supporting approaches between the survivals and dead were not significantly different（P>0.05）,while the percentage of older than 50 yr and the incidence of complications in the survivals were significantly lower than those in the dead （40.4% and 46.1% vs. 61.8% and 79.4%,P<0.05）;serum PAB,TBA,BUN,Cr and HBV DNA levels in the two groups were not significantly different（P>0.05）,while serum bilirubin and prothrombin time in the survivals were significantly lower than in the dead（P<0.05）,and serum albumin,cholinesterase,total cholesterol and alpha-protein levels in the survivals were significantly higher than those in the dead（P<0.05）;the incidences of hepatic encephalopathy,hepatorenal syndrome,blood electrolyte imbalance and various complications in the survival group were 7.7%,1.9%,15.4% and 11.5%,much lower than 45.6%,14.7%,39.7% and 26.5% in the dead,respectivley （P<0.05）,while the incidences of upper gastrointestinal hemorrhage and spontaneous bacterial peritonitis in the two groups were not significantly different （P>0.05）;the Logistic analysis showed that the patients’age,blood prothrombin time, hepatic encephalopathy,electrolyte imbalance and complications were the independent factors influencing the prognosis of patients with hepatitis B-induced ACLF. Conclusion The clinicians should take the influencing factors of prognosis into consideration for early diagnosis and appropriate management of patients with ACLF in clinical practice to improve the survivals,which might include decreasing the occurrence of related complications and promoting liver regeneration in time.

Key words: Acute-on-chronic liver failure, Hepatitis B, Prognosis, Influencing factors

彭思璐, 刘冰, 孙宏, 林剑, 潘志颖, 邓存良. HBV相关慢加急性肝衰竭患者预后及其影响因素分析^*[J]. 实用肝脏病杂志, 2019, 22(4): 545-548.

Peng Silu, Liu Bing, Sun Hong, et al. Prognosis of patients with hepatitis B-induced acute-on-chronic liver failure[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2019, 22(4): 545-548.

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HBV相关慢加急性肝衰竭患者预后及其影响因素分析^*

Prognosis of patients with hepatitis B-induced acute-on-chronic liver failure

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