乙型肝炎相关慢加急性肝衰竭患者的预后因素分析  

Prognostic factors for hepatitis B acute-on-chronic liver failure

作　　者：张冬青[1] 陈立[2] 甘巧蓉[2] 周锐[2] 黄建荣[3] 潘晨[1,2] 

机构地区：[1]福建医科大学第一临床医学院,福州350001 [2]福州市传染病医院,福州350025 [3]浙江大学医学院附属第一医院,杭州310006

出　　处：《临床肝胆病杂志》2012年第10期740-743,共4页Journal of Clinical Hepatology

基　　金：艾滋病和病毒性肝炎等重大传染病防治科技重大专项(2008ZX10002-005);福州市科技计划项目(2009-G-102);国家自然科学基金项目(81000759)

摘　　要：目的探讨影响乙型肝炎相关慢加急性肝衰竭患者预后的危险因素。方法记录263例乙型肝炎相关慢加急性肝衰竭患者治疗基线时血清胆碱酯酶、白蛋白及胆固醇等反应肝脏储备功能的临床指标及重要并发症的发生情况,并计算其MELD评分。所有患者随访满1年。通过Cox比例风险回归模型筛选出影响预后的独立危险因素。结果在1年的随访时间内,67例死亡,病死率为25.5%。死亡组血清胆碱酯酶、白蛋白、胆固醇水平均较存活组低。血清胆固醇水平随着MELD值的升高而下降。Cox比例风险回归模型分析得出,肝性脑病、肝肾综合征、上消化道出血、胆固醇≤2.5 mmol/L、MELD评分≥30是影响乙型肝炎相关慢加急性肝衰竭患者预后的独立危险因素,RR分别为6.286、2.983、2.272、2.168及1.853。结论胆固醇≤2.5 mmol/L、肝性脑病、肝肾综合征、上消化道出血及MELD评分≥30是决定乙型肝炎相关慢加急性肝衰竭患者预后的主要危险因素。Objective To investigate the prognostic value of risk factors in hepatitis B patients with acute - on - chronic liver failure （ACLF）. Methods A total of 263 patients with hepatitis B - ACLF were enrolled in the study. The baseline levels of albumin （ Alb）, cholinesterase （CHE）, and total cholesterol （TC） were measured, any complications were recorded, and the MELD score was calculated. All of the patients were followed - up for one year. The prognostic value of known risk factors was analyzed by the multivariate Cox propor- tional hazard model. Results Sixty - seven patients died within the 1 - year follow - up period, yielding a mortality rate of 25.5%. The baseline levels of Alb, CHE, and TC were all significantly lower in the patients who ultimately died than in those who survived. The serum TC level was found to be inversely correlated with increases in the MELD score. Hepatic encephalopathy, hepatorenal syndrome, gastrointes- tinal bleeding, TC ≤2.5 mmol/L, and MELD score ≥30 were identified as independent prognostic factors for hepatitis B -ACLF. Conclu- sion Several risk factors of hepatitis B - ACLF are prognostic factors of disease outcome, namely death within one year, including hepatic encephalopathy, hepatorenal syndrome, gastrointestinal bleeding, TC ≤2.5 mmol/L, and MELD≥30.

关 键 词：肝炎病毒 乙型 肝功能衰竭 危险因素 预后 

分 类 号：R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学]