HBV相关慢加急性肝衰竭患者血乳酸水平影响因素分析  

Factors affecting serum lacticemia level in patients with HBV-related acute-on-chronic liver failure

作　　者：陈婧[1,2] 胡瑾华[1,2] 刘晓燕[2] 段学章[2] 何卫平[2] 王慧芬[2] 

机构地区：[1]解放军军医进修学院,北京100853 [2]解放军第三〇二医院肝衰竭治疗研究中心,北京100039

出　　处：《传染病信息》2011年第3期156-158,184,共4页Infectious Disease Information

基　　金：中美重大肝病合作计划(2009DFA32450);国家"十一五"科技重大专项(2008ZX10002-005-6);首都医学发展科研基金重点课题(20072026)

摘　　要：目的观察HBV相关慢加急性肝衰竭(HBV-related acute-on-chronic liverfailure,HBV-ACLF)患者接受核苷类似物抗病毒治疗过程中血清乳酸的变化并探讨其意义。方法回顾性分析2009—2010年于我院治疗的74例HBV-ACLF患者的临床资料,分析乳酸升高与核苷类似物、感染、肝肾综合征以及生化指标的关系。结果服用恩替卡韦或拉米夫定的2组患者乳酸升高比率的差异无统计学意义。乳酸水平升高与感染、肝肾综合征的发生有关(χ2值分别为9.417和6.158,P值分别为0.002和0.013)。临床无确切引起乳酸升高原因的3例患者,乳酸呈一过性升高,且预后良好。结论 HBV-ACLF患者抗病毒治疗过程中乳酸升高主要原因是感染和肝肾综合征。核苷类似物治疗HBV-ACLF未引发显著的乳酸升高,安全性良好。Objective To evaluate the changes of serum lactate level and its significance in patients with HBV-related acute- on-chronic liver failure （HBV-ACLF） receiving nueleoside analogue antiviral therapy. Methods Clinical data of 74 HBV-ACLF patients treated in our hospital from 2009 to 2010 were retrospectively ana/yzed, and the relationship between increased serum lactate level and nucleoside analogues, infection, hepatorenal syndrome and biochemical indicators were evaluated. Results The proportions of the patients with increased lactate level were not significantly different between the patients receiving entecavir and those receiv- ing lamivudine. The increased lactate level was related to the occurrence of infection（X^2=9.417, P=-0.002） and hepatorenal syndrome （X^2=6.158, P=0.013 ）. Only 3 patients had no other suspected causes of laetieemia, and the serum lactate levels in these patients returned to normal with good prognosis. Conclusions The increased lactate level in HBV-ACLF patients receiving antiviral therapy is mainly caused by infection and hepatorenal syndrome. Antiviral treatment with nucleoside analogues does not result in the increased lactate level in HBV-ACLF patients with sound safety.

关 键 词：乙型肝炎 慢加急性肝衰竭 乳酸 抗病毒治疗 核苷类似物 

分 类 号：R512.62[医药卫生—内科学]