乙型肝炎相关慢加急性肝衰竭患者预后的危险因素分析  

Prognostic risk factors in patients with hepatitis B virus- related acute- on- chronic liver failure

作　　者：石新星[1] 张艳琼[1] 朱鹏[1] 闫国华[1] 张长江[1] 王宇明[1] 

机构地区：[1]第三军医大学西南医院全军感染病研究所,重庆400038

出　　处：《临床肝胆病杂志》2016年第4期700-705,共6页Journal of Clinical Hepatology

基　　金：国家"十二五"科技重大专项(2012ZX10002004);国家自然科学基金面上项目(81270536)

摘　　要：目的探讨乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者的临床特征及远期预后的危险因素。方法回顾性分析第三军医大学西南医院2010年1月^(-2)015年1月住院的1116例HBV-ACLF患者的临床资料,观察影响患者1年生存时间及预后的危险因素,通过Cox回归模型筛选出影响预后的独立危险因素。计量资料组间比较采用t检验或t'检验,计数资料组间比较采用χ~2检验。结果在随访的1年时间内,562例患者死亡,病死率为50.4%。生存组和死亡组比较:年龄、ALT、TBil、尿素氮、血肌酐、国际标准化比值、血清Na+、白细胞(WBC)、中性粒细胞百分比、血小板(PLT)、HBV DNA载量、MELD评分、腹水、自发性细菌性腹膜炎、消化道出血、肺部感染、脓毒症、电解质紊乱、肝性脑病及急性肾损伤(AKI)在2组间的差异均有统计学意义(P值均<0.05)。Cox回归分析结果显示:年龄、WBC、MELD评分、肝性脑病、电解质紊乱、AKI及PLT是HBV-ACLF患者1年病死率的独立危险因素(P值均<0.05)。结论 HBV-ACLF是一个高病死率疾病,常常合并多种严重并发症。而影响HBV-ACLF患者1年病死率的主要危险因素包括年龄、WBC、MELD评分、肝性脑病、电解质紊乱、AKI及低PLT水平。Objective To investigate the clinical characteristic and long- term prognosis risk factor of patients with hepatitis B virus- related acute- on- chronic liver failure（ HBV- ACLF）. Methods The clinical data of 1116 HBV- ACLF patients who were hospitalized in Southwest Hospital of Third Military Medical University from January 2010 to January 2015 were analyzed retrospectively. The risk factors for1- year survival time and prognosis were observed,and the Cox regression model was used to determine the independent risk factors for the prognosis of these patients. The t- test or t＇- test was applied for comparison of continuous data between groups,and the chi- square test was applied for comparison of categorical data between groups. Results A total of 562 patients died within the 1- year follow- up period,and the fatality rate was 50. 4%. The comparison between the survival group and the death group showed that age,alanine aminotransferase,total bilirubin,urea nitrogen,serum creatinine,international normalized ratio,serum Na＋,white blood cell（ WBC）,percentage of neutrophils,platelet（ PLT）,HBV DNA load,Model for End- Stage Liver Disease（ MELD） score,ascites,spontaneous bacterial peritonitis,gastrointestinal bleeding,pulmonary infection,sepsis,electrolyte disturbance,hepatic encephalopathy,and acute kidney injury（ AKI）were the risk factors for death within 1 year（ all P〈0. 05）. The Cox regression analysis showed that age,WBC,MELD score,hepatic encephalopathy,electrolyte disturbance,AKI,and PLT were the independent risk factors for the 1- year fatality in HBV- ACLF patients（ all P〈0. 05）. Conclusion Our findings show that HBV- ACLF has a high fatality rate and is often accompanied by serious complications.The major risk factors affecting the 1- year fatality in HBV- ACLF patients are age,WBC,MELD score,hepatic encephalopathy,electrolyte disturbance,AKI,and PLT.

关 键 词：肝功能衰竭 肝炎病毒 乙型 危险因素 预后 

分 类 号：R575.3[医药卫生—消化系统]