伴有中/重度食管静脉曲张的慢加急性肝衰竭患者预后危险因素分析*

doi:10.3969/j.issn.1672-5069.2022.03.022

实用肝脏病杂志 ›› 2022, Vol. 25 ›› Issue (3): 391-394.doi: 10.3969/j.issn.1672-5069.2022.03.022

伴有中/重度食管静脉曲张的慢加急性肝衰竭患者预后危险因素分析^*

孙亚男, 曾庆环, 刘远志, 张世斌, 李鹏, 武永乐, 丁惠国

100069 北京市首都医科大学附属北京佑安医院肝病消化中心

收稿日期:2021-05-12 出版日期:2022-05-10 发布日期:2022-05-17
通讯作者: 丁惠国,E-mail:dinghuiguo@ccmu.edu.cn
作者简介:孙亚男,女,36岁,硕士研究生。主要从事各种类型肝病的临床诊治研究。E-mail:sunyananyayy@ccmu.edu.cn
基金资助:
^*国家病毒性肝炎和艾滋病等重大传染病防治专项基金资助项目(编号:2017ZX10203202-004)

Influencing factors for prognosis of patients with acute-on-chronic liver failure and moderate or severe esophageal varices

Sun Yanan, Zeng Qinghuan, Liu Yuanzhi, et al

Centre of Hepatic and Digestive Diseases, You’an Hospital, Capital Medical University, Beijing 100069,China

Received:2021-05-12 Online:2022-05-10 Published:2022-05-17

摘要/Abstract

摘要： 目的探讨影响伴有中/重度食管静脉曲张的B型和C型慢加急性肝衰竭(ACLF)患者预后的因素。方法 2017年11月1日～2020年3月31日我院住院的首次诊断的ACLF患者58例,其中B型18例(31.0%),C型40例(69.0%),胃镜检查提示存在中/重度食管静脉曲张,随访 6个月。应用Logistic回归分析,探讨影响生存率的独立危险因素。结果在随访的6个月内,20例(34.5%)死亡,1例行肝移植,2例失访,35例(60.3%)生存;生存组与死亡组患者在腹水量(P=0.039)、住院期间是否行硬化剂治疗(P=0.010)、临床分型(P=0.034)、肝性脑病(P=0.029)和静脉曲张程度(P=0.046)方面差异具有统计学意义(P<0.05);非条件Logistic回归分析分析腹水量(OR=9.76)、住院期间是否行硬化剂治疗(OR=19.28)和肝性脑病(OR=5.98)均是影响患者6个月生存率的独立危险因素。结论存在大量腹水、严重肝性脑病和食管静脉曲张硬化剂治疗可能严重影响ACLF患者生存,临床医生应尽快控制并发症,不推荐进行硬化剂治疗静脉曲张。

关键词: 慢加急性肝衰竭, 食管静脉曲张, 硬化剂治疗术, 危险因素, 预后

Abstract: Objective The aim of this study was to investigate the prognostic factors of patients with type B and type C acute-on-chronic liver failure(ACLF) and moderate or severe esophageal varices (EV). Methods The clinical materials in 58 patients with ACLF (type B in 18, and type C in 40) and moderate to severe EV between November 1,2017 and March 31,2020 in our hospital were retrospectively analyzed. All patients were followed-up for 6 months. The Logistic regression analysis was applied to explore the independent risk factors affecting the 6-month survival rate. Results At the end of six month followed-up, 20 patients (34.5%) died, 1 received liver transplantation, 2 lost and 35 (60.3%) survived; there were significant differences respect to ascites volume(P=0.039), esophageal vein sclerotherapy (EVS)(P=0.010), ACLF clinical types (P=0.034), different stages of hepatic encephalopathy(P=0.029) and degree of varices (P=0.046) between dead and survivals; the Logistic regression analysis showed that the ascites (OR=9.76), sclerotherapy during hospitalization (OR=19.28) and hepatic encephalopathy (OR=5.98) were the independent risk factors for 6-month survival rate. Conclusion The ACLF patients with massive ascites, severe hepatic encephalopathy and EVS treatment might have a poor short-term prognosis, and we do not recommend EVS for patients with ACLF at this setting.

Key words: Acute-on-chronic liver failure, Esophageal varices, Sclerotherapy, Risk factors, Prognosis

孙亚男, 曾庆环, 刘远志, 张世斌, 李鹏, 武永乐, 丁惠国. 伴有中/重度食管静脉曲张的慢加急性肝衰竭患者预后危险因素分析^*[J]. 实用肝脏病杂志, 2022, 25(3): 391-394.

Sun Yanan, Zeng Qinghuan, Liu Yuanzhi, et al. Influencing factors for prognosis of patients with acute-on-chronic liver failure and moderate or severe esophageal varices[J]. Journal of Practical Hepatology, 2022, 25(3): 391-394.

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伴有中/重度食管静脉曲张的慢加急性肝衰竭患者预后危险因素分析^*

Influencing factors for prognosis of patients with acute-on-chronic liver failure and moderate or severe esophageal varices

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