CLIF-C OFs在乙型肝炎相关慢性肝病急性失代偿患者中鉴别慢加急性肝功能衰竭的临床研究  

Clinical study on CLIF-C OFs for distinguishing acute-on-chronic liver failure from HBV-related chronic liver disease with acute decompensation

作　　者：周惠娟[1] 汤伟亮[1] 陆小波[1] 胡沛[1] 姜绍文[1] 徐玉敏[1] 曹竹君[1] 赖荣陶[1] 王晖[1] 蔡伟[1] 谢青[1] 余敏杰[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院感染科,200025

出　　处：《肝脏》2017年第5期396-399,共4页Chinese Hepatology

基　　金：国家十二五科技重大专项(2013ZX10002005;2013ZX10002004;2014ZX10005001);国家临床重点专科建设项目(感染病学);上海市公共卫生三年行动计划重点学科建设项目传染病与卫生微生物学(15GWZK0102)

摘　　要：目的探究欧洲肝病学会提出的适用于以酒精为病因引起的慢加急性肝衰竭诊断标准(CLIF Consortium Organ Failure score,CLIF-C OF)是否适用于乙型肝炎相关的慢加急性肝衰竭。方法筛选并纳入2005年1月至2010年12月上海瑞金医院乙型肝炎相关慢性肝病急性失代偿患者854例,按CLIF-C OF标准分为ACLF组和非ACLF组。分析ACLF组和非ACLF组的临床和实验室指标、病情严重程度和短期病死率。结果 ACLF组262例和非ACLF组592例。ACLF组较非ACLF组年龄大,肝、肾、脑、凝血、循环、呼吸功能衰竭情况均显著高于入院非ACLF组(P<0.01),28 d和90 d病死率均显著升高(27.1%比3.1%、39.6%比4.9%,P<0.01),提示病情更重。结论欧洲肝病学会所提出的评分标准可从乙型肝炎相关慢性肝病合并急性失代偿患者中筛选出一组病情更为危重、病死率更高的慢加急性肝衰竭患者群体。乙型肝炎相关慢性肝病并发急性失代偿患者中确实存在一群疾病程度更严重的ACLF群体,CLIF-C OF标准可将ACLF患者从乙型肝炎相关慢性肝病并发急性失代偿患者中区分出来,以指导临床医生治疗决策。Objective To investigate the applicability of chronic liver failure consortium organ failure score（CLIF-C OFs）in diagnosing hepatitis B virus（HBV）-related acute-on-chronic liver failure（ACLF）,which was initially proposed by European association for the study of the liver（EASL）for diagnosing alcoholic ACLF.Methods A total of 854 consecutive HBV-related chronic liver disease patients with acute decompensation（AD）from January 2005 to December 2010 in our hospital were enrolled.Patients were divided into ACLF group and non-ACLF group according to CLIF-C OFs,whose clinical data,biochemistry characteristics,disease severity and short-term mortality rate were analyzed,respectively.Results Among the 854 patients,there were 262 in ACLF group and 592 in non-ACLF group.Compared with non-ACLF group,patients in ACLF group were older with higher incidence of liver,renal,cerebral,coagulation,circulatory and respiratory failure,respectively（P〈0.01）.Moreover,28-day mortality and 90-day mortality in ACLF group were also higher than that in non-ACLF group（27.1% vs 3.1% and 39.6% vs 4.9%,P〈0.01）.Conclusion CLIF-C OFs can help distinguish a severe ACLF subgroup with high mortality from HBV-related chronic liver disease patients with AD,which is benefit for clinical management.

关 键 词：乙型肝炎 急性失代偿 慢加急性 肝功能衰竭 

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