严重乙型肝炎活动进展为肝衰竭的预后因素分析  

Serum total bilirubin,prothrombin,HBeAg,and PC mutant-predictors of severe acute exacerbation in patients with chronic hepatitis B

作　　者：杨玲[1,2] 焦倩[1] 曾文铤[1] 梁增伟[1] 谢栩硕[1] 

机构地区：[1]广州医学院附属第一医院感染内科,广州510120 [2]广州南方医科大学南方医院肝病中心,广州510150

出　　处：《中国人兽共患病学报》2014年第12期1218-1222,共5页Chinese Journal of Zoonoses

基　　金：广东省教育厅课题(No.2013LYM_0074);广州医学院课题(No.2011C36)联合资助~~

摘　　要：目的旨在探讨影响严重肝炎活动预后的因素。方法应用Logistic回归分析69例严重肝炎活动患者,探讨可能与进展成肝衰竭相关的临床和病毒学指标,包括HBV基因型、PC(G1896A)及BCP(A1762T/G1764A)变异;筛选出独立预测因素。结果严重活动性肝炎患者中,33例(47.8%)进展成肝衰竭。多因素分析筛选出总胆红素升高(TB>256μmol/dL,P=0.008)及凝血功能异常(PTA<40%,P<0.001)是严重肝炎活动进展为肝衰竭的危险因素。HBeAg阴性(P=0.065)、PC变异(P=0.090)与病情恶化有一定相关性。结论血清总胆红素水平、凝血功能、HBeAg状态及PC变异在预测HBV相关的严重肝炎活动进展为肝衰竭中有预测价值。In this study, we elucidated the predictors of progression to liver failure during severe acute exacerbation. We analyzed 69 consecutive patients with severe acute exacerbation of chronic hepatitis B for clinical outcome and factors that influ enced the development of liver failure, including viral genotype, PC （G1896A） and BCP （A1762T/G1764A） mutants. Thirty- three （47.8M） severe acute exacerbation patients progressed to liver failure. Multivariate analysis identified serum bilirubin （TB〉256 μmol/dL, P=0. 008） and prothrombin activity （PTA〈40%, P〈0. 001） as significant determinants of progression to liver failure. HBeAg negativity （P=0. 065） and PC mutant （P=0. 090） were associated with the progression to hepatic decompensation. Serum total bilirubin, prothrombin activities, HBeAg status and PC mutant were predictors of clinical outcome in patients with severe acute exacerbation of chronic hepatitis B.

关 键 词：乙型肝炎病毒 肝衰竭 病毒变异 

分 类 号：R373.2[医药卫生—病原生物学]