脾脏肿大慢加急性肝衰竭病人的临床特点  

Clinical characteristics of patients with acute-on-chronic liver failure and splenomegaly

作　　者：张明霞[1] 覃国琦[2] 李峰[3] 张琪[1] 何钦俊 何雅静[1] 罗文凡[1] 王程[1] 陈金军[1] 

机构地区：[1]南方医科大学南方医院肝病中心,广东广州510515 [2]解放军303医院感染内科,广西桂林530021 [3]厦门大学附属中山医院感染内科,福建厦门361004

出　　处：《南方医科大学学报》2014年第9期1310-1313,共4页Journal of Southern Medical University

基　　金：国家自然科学基金(81270533);教育部高等学校博士学科点专项科研基金(20124433120016);广东省自然科学基金(S2011010003805)~~

摘　　要：目的了解脾脏肿大慢性肝病患者发展为慢加急性肝衰竭后的临床特点和短期预后。方法回顾性收集慢性乙型肝炎病毒感染相关的慢加急性肝衰竭病例,描述和分析脾脏肿大病人的临床特点。结果共纳入149例病人,4周死亡率48.3%。与无脾脏肿大者相比,脾脏肿大的病人外周血小板计数（G/L）降低（78 vs 113,P=0.001）,丙氨酸氨基转移酶（ULN）水平低（1.98 vs4.73,P=0.005）,凝血酶原时间国际标准化率低（2.03 vs 2.33,P=0.010）,肝性脑病总体发生率接近（39.8%vs 38.8%,P=1.000）,但脾脏肿大者多为1~2级肝性脑病（P〈0.001）。脾脏肿大者4周死亡率低（P=0.034）,但90 d死亡率接近。脾脏肿大是4周死亡的独立保护因素（RR=1.939,P=0.038）,其他与4周死亡独立相关的因素包括中性粒细胞比例大于70%（RR=1.791,P=0.049）、肝性脑病（RR=1.806,P=0.001）、血清肌酐水平（RR=1.457,P=0.004）及凝血酶原时间国际标准化率（RR=1.205,P=0.018）。新模型的预测价值优于终末期肝病模型（曲线下面积0.860 vs 0.792,P=0.017）。结论脾脏肿大的慢加急性肝衰竭病人具有相对独特的临床特征。Objective To observe the clinical characteristics and short-term survival of patients with splenomegaly and acute-on-chronic liver failure related to chronic HBV infection. Methods Electronic medical records of patients with acute-on-chronic liver failure were collected to analyze the clinical parameters and 4-week survival of patients with or without splenomegaly. Results Of the 149 patients enrolled, the overall 28-day mortality rate was 48.3%, which was lower in patients with enlarged spleen than those without （34.2% vs 54.1% , P=0.034）. Compared with patients without splenomegaly, patients with splenomegaly had lower platelet counts （P=0.001）, lower ALT levels （P--0.005） and lower PT-INR （P=0.010）. Although the occurrence of hepatic encephalopathy was comparable between patients with or without splenomegaly, severe conditions were more frequent in those without splenomegaly. Hepatic encephalopathy grades, serum creatinine levels, neutrophil percentages over 70%, PT-INR and splenomegaly were independent factors associated with the 28-day survival, and this novel model was superior to model of end-stage of liver disease in predicting the 4-week survival （P=0.017）. Conclusion Patients with splenomegaly that evolves into acute-on-chronic liver failure have unique clinical characteristics and further clinical observations are warranted.

关 键 词：慢加急性肝衰竭 乙型肝炎病毒 脾脏肿大 

分 类 号：R575.3[医药卫生—消化系统]