乙型肝炎相关慢加急性肝衰竭患者早期及远期预后的影响因素比较分析  

Comparative analysis of influential factors of early and long-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure

作　　者：沈扬林 李孟英[1] 谭可平[1] 陈婵[1] 陆晖 覃国琦[1] 甘琼萍 

机构地区：[1]中国人民解放军第303医院感染科,530021

出　　处：《中国实用医药》2017年第32期8-10,共3页China Practical Medicine

摘　　要：目的探讨乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)早期及远期预后的影响因素。方法 HBV-ACLF患者262例,对患者的临床转归情况进行回顾性随访,终止时间为2017年1月,所有患者均进行综合治疗,根据患者的情况给予人工肝置换治疗或给予核苷酸类药物(NAs)治疗,分析比较患者的早期及远期预后影响因素。结果随访截止2017年1月,262例HBV-ACLF患者中,存活49例,存活率为18.70%;死亡190例,死亡率为72.52%;失访23例,失访率为8.78%。平均生存时间为(48.6±3.6)个月,95%可信区间(43.7,55.7)个月。HBV-ACLF早期(6个月)预后的影响因素从小到大依次是总胆红素(TBIL)水平、血清胆碱酯酶(CHE)水平、人工肝血浆置换(PE)治疗次数、乙型肝炎病毒(HBV)脱氧核糖核酸(DNA)水平、NAs抗病毒治疗、合并肝性脑病、中性粒细胞比率、年龄、终末期肝病模型(MELD)评分,差异具有统计学意义(P<0.05)。HBV-ACLF远期(10年)预后的影响因素从小到大依次是合并肝性脑病、性别、外周血白细胞(WBC)水平、合并感染、CHE水平、MELD评分、NAs抗病毒治疗、年龄,差异具有统计学意义(P<0.05)。结论 HBV-ACLF早期及远期预后的影响因素比较有明显差异,早期以及远期的随访中,应给予患者NAs抗病毒药物持续治疗,这能有效防止并发症的发生和感染,并改善肝脏功能。Objective To discuss the influential factors of early and long-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure（HBV-ACLF）. Methods Retrospective follow-up were made on clinical outcomes of 262 HBV-ACLF patients. The termination time was January 2017, and all patients received comprehensive therapy. According to the condition of patients, artificial liver replacement therapy or nucleoside and nucleotide analogs（NAs） treatement was performed, so as to analze and compare the influential factors of early and long-term prognosis. Results In termination time of January 2017, there were 49 survived cases, with survival rate as 18.70%, 190 death cases, with death rate as 72.52%, and 23 lost cases, with lost rate as 8.78% in 262 HBV-ACLF patients. Patients had mean survival time as（48.6±3.6） months, 95% confidence interval as（43.7, 55.7） months. The influencing factors of HBV-ACLF in the early stage（6 months） from small to large were the levels of total bilirubin（TBIL）, serum cholinesterase（CHE）, artificial liver plasma exchange（PE） treatment times, hepatitis B virus（HBV） deoxyribonucleic acid（DNA）, NAs antiviral therapy, combined with hepatic encephalopathy, neutrophil ratio, age, model for end-stage liver disease（MELD） score respectively, and the difference was statistically significant（P〈0.05）. The influencing factors of HBV-ACLF in long-term（10 years） form small to large were combined with hepatic encephalopathy, gender, peripheral white blood cell（WBC） levels, combined infection, CHE levels, MELD scores, NAs antiviral therapy and age, and the difference was statistically significant（P〈0.05）. Conclusion The influencing factors of of early and long-term prognosis of HBV-ACLF were significantly different. In early and long-term follow-up, NAs antiviral drugs continued treatment should be performed, and it can effectively prevent the occurrence and infection of complications and improve liver function.

关 键 词：乙型肝炎 慢加急性肝衰竭 预后 影响因素 

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