乙型肝炎肝衰竭的临床特征及治疗分析  

Analysis of the clinical characteristics and treatment of hepatitis B virus-related liver failure

作　　者：刘平[1,2] 龚作炯[2] 孟忠吉[2] 

机构地区：[1]十堰市太和医院(湖北医药学院附属医院)感染科,湖北十堰442000 [2]武汉大学人民医院感染科

出　　处：《中西医结合肝病杂志》2015年第2期69-73,85,共6页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：湖北省自然科学基金(No.2014CFB645;2010CDZ036)

摘　　要：目的:揭示乙型肝炎肝衰竭患者的临床特征,探讨乙型肝炎肝衰竭患者病情进展和预后预测指标,分析乙型肝炎肝衰竭适用的治疗方法。方法:收集并分析我科2012年7月至2014年3月收治入院的100例乙型肝炎肝衰竭患者的临床资料、实验室检查指标、并发症、生存率、治疗措施以及不良事件。结果:100例乙型肝炎肝衰竭患者中,HBV相关慢加急性肝衰竭(HBV-ACLF)和HBV相关慢性肝衰竭(HBV-CLF)分别为86例和14例,无急性和亚急性肝衰竭病例。HBV-ACLF和HBV-CLF在性别比例、TBil、Alb、PT、HBV DNA、HBe Ag阳性率、自发性腹膜炎(SBP)发生率、4周死亡率等方面差异无显著性意义。但是与HBV-ACLF相比,HBV-CLF发病年龄高(P<0.05),PLT水平低(P<0.05),腹水(Asitice)、肝性脑病(HE)、消化道出血(Bleeding)的发生率较高(P<0.05)。而与HBV-CLF比较,HBV-ACLF在诊断时具有更高的ALT水平(P<0.05)。另外,血清Na+水平越低,生存率越低。发生HE、Bleeding、SBP患者4周死亡率明显高于未发生并发症者。使用核苷(酸)类似物抗病毒患者与未使用此药物患者比较,短期(4周)实验室检查指标除HBV DNA外,其余各项及生存率差异均无显著性意义。结论:ACLF和CLF为乙型肝炎肝衰竭的主要临床亚型。血清Na+、HE、SBP、Bleeding是患者近期预后的独立预测因素。乙型肝炎肝衰竭患者使用核苷(酸)类似物抗病毒治疗安全有效,持续的病毒抑制可能改善患者的远期预后。Objective：To investigate the clinical characteristics of HBV-related liver failure （HBV-LF）, to explore the predictors for progress and prognosis, and to analyze the applicable therapeutic regimes of HBV-LF.Methods：All the patients who suffered from HBV-LF hospitalized in our clinic from July 2012 to March 2014 were included in this study.The clinical manifestations, laboratory findings, compli-cations, outcomes, mortality, treatment interventions, and adverse events were collected and analyzed.Results：There were all together 100 patients with HBV-LF, 86 of which suffered from acute-on-chronic liver failure （ACLF）, and the rest 14 patients suffered from chronic liver failure （CLF）, HBV related acute or subacute liver failure were not diagnosed.There were no significant differences between HBV-ACLF and HBV-CLF in the context of gender,total bilirubin, albumin, prothrombin time, HBV DNA, HBeAg status, Spontaneous bacterial Perito-nitis （SBP） rate, and Mortality within four weeks （P 〉0.05）.Elder age （P 〈0.05）, lower PLT levels （P 〈0.05）, and higher incidence （P〈0.05） of ascites,hepatic encephalopathy （HE）, and gastrointestinal bleeding were revealed in patients with HBV-CLF than those with HBV-ACLF, whereas patients with HBV-ACLF exhibited higher ALT levels than those with HBV-CLF when they were diagnosed.Lower ser-um sodium levels always leaded to lower survival rate （P 〈0.05）.The mortality at week four was significantly higher in patients with compli-cations of HE, gastrointestinal bleeding, or SBP than those without complications.No significant difference was found between patients re-ceived nucleos（t）ide analogues treatment or not, in the aspects of laboratory test and survival rates at week four, except HBV DNA loads. Conclusion：ACLF and CLF are the main clinical subtypes of HBV-LF.Serum sodium, HE, SBP, and bleeding are independent predictors of short-term prognosis in patients with HBV-LF.Nucleos（t）ide analogues are safe and effective for patie

关 键 词：肝炎乙型 肝衰竭 临床特征 治疗 

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