中西医结合治疗HBV相关慢加急性肝衰竭合并肝性脑病的效果分析  

Clinical effect of integrated traditional Chinese and Western medicine therapy in patients with hepatitis B virus-related acute-on-chronic liver failure complicated by hepatic encephalopathy

作　　者：宫嫚[1] 周超 张宁[1] 孙克伟[2] 张振刚 李瀚旻[4] 李秀惠[5] 杨宏志 李芹[7] 王林 周小舟[9] 毛德文[10] 过建春 卓蕴慧[12] 王宪波 邓欣[14] 王介非 曹武奎[16] 张淑琴 张明香[18] 李筠[1] GONG Man;ZHOU Chao;ZHANG Ning;et al(Liver Disease Center for Combined TCM and Western Medicine, 302 Hospital of PLA, Bei- ring 100039, China)

机构地区：[1]中国人民解放军第三〇二医院中西医结合肝病中心,北京100039 [2]湖南中医药大学第一附属医院,长沙410000 [3]华中科技大学附属同济医院,武汉430030 [4]湖北省中医院,武汉430060 [5]首都医科大学附属北京佑安医院,北京100069 [6]中山大学附属第三医院,广州510630 [7]福州市传染病医院,福州350025 [8]成都市公共卫生临床医疗中心,成都610061 [9]深圳市中医院,广东深圳518033 [10]广西中医药大学第一附属医院,南宁530023 [11]杭州市西溪医院,杭州310023 [12]上海中医药大学附属曙光医院,上海201203 [13]首都医科大学附属北京地坛医院,北京100102 [14]深圳市第三人民医院,广东深圳518040 [15]上海公共卫生临床中心,上海201508 [16]天津市第二人民医院,天津300192 [17]吉林省肝胆病医院,长春130062 [18]沈阳市第六人民医院,沈阳110006

出　　处：《临床肝胆病杂志》2018年第4期795-800,共6页Journal of Clinical Hepatology

基　　金：国家科技重大专项(2012ZX10005-005;2018ZX10725506-002);国家中医药管理局专项课题(JDZX2015187)

摘　　要：目的探讨中西医结合治疗HBV相关慢加急性肝衰竭(ACLF)合并肝性脑病(HE)患者8周病死率情况,分析影响其预后的独立危险因素。方法选取2012年1月-2015年2月18家医院收治的HBV-ACLF患者,采用随机对照设计分为试验组和对照组,分别给予中西医结合治疗和单纯西医综合治疗,纳入所有0周合并HE的患者125例。观察2组8周病死率情况。计量资料2组间比较采用t检验或Mann-Whitney U检验,计数资料2组间比较采用χ2检验,生存分析采用Kaplan-Meier方法及logrank检验,危险因素分析采用Cox比例风险回归模型。结果试验组及对照组8周病死率分别为27.5%、50.0%(χ~2=5.630,P=0.018),8周内中位生存时间分别为41.2 d、28.4 d,累积生存概率分别为60.4%、32.5%(χ~2=6.187,P=0.013);Cox回归分析结果显示与对照组相比,试验组是HBV-ACLF合并HE患者预后的保护因素[风险比(HR)=0.424,P=0.018,95%可信区间(95%CI):0.208~0.864],高TBil(HR=1.063,P=0.042,95%CI:1.002~1.128)、低PTA(HR=0.942,P=0.044,95%CI:0.890~0.998)、ACLF分期晚期(HR=2.737,P=0.009,95%CI:1.287~5.818)、合并消化道出血(HR=5.291,P=0.003,95%CI:1.736~16.126)是8周死亡的独立危险因素。结论中医药治疗可显著降低HBV-ACLF合并HE患者的8周病死率,提高8周生存概率,延长生存时间。TBil、PTA、疾病分期、消化道出血是该组患者的独立预后影响因素。Objective To investigate the 8-week mortality rate of patients with hepatitis B virus（HBV）-related acute-on-chronic liver failure（ACLF） complicated by hepatic encephalopathy（HE） treated with integrated traditional Chinese and Western medicine therapy,as well as independent prognostic factors.Methods A total of 125 HBV-ACLF patients with HE who were admitted to 18 hospitals from January 2012 to February 2015 were enrolled and divided into trial group and control group using a randomized controlled design.The patients in the trial group were given integrated traditional Chinese and Western medicine therapy,and those in the control group were given Western medicine therapy alone.The 8-week mortality rate was observed for both groups.The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups; the chi-square test was used for comparison of categorical data between groups; the Kaplan-Meier method and the log-rank test were used for survival analysis; the Cox proportional hazards regression model was used for the analysis of risk factors.Results The 8-week mortality rate was 27.5% in the trial group and 50.0% in the control group（χ2= 5.630,P = 0.018）,the median survival time was 41.2 days in the trial group and 28.4 days in the control group,and the 8-week cumulative probability of survival was 60.4% in the trial group and 32.5% in the control group（χ2= 6.187,P = 0.013）.The Cox regression analysis showed that compared with the control group,the trial group was a protective factor in patients with HBV-ACLF complicated by HE（hazard ratio [HR]= 0.424,95% confidence interval [CI]：0.208-0.864,P = 0.018）.There were significant differences between the two groups in total bilirubin（TBil）（HR = 1.063,95% CI：1.002-1.128,P = 0.042）,prothrombin activity（PTA）（HR = 0.942,95% CI：0.890-0.998,P = 0.044）,ACLF stage（HR = 2.737,95% CI：1.287-5.818,P = 0.009）,and the presence or absence of gastrointestinal hemorrhage（HR = 5.291,95% CI：1.736-16.126,P

关 键 词：肝功能衰竭 肝性脑病 肝炎病毒 乙型 中西医结合疗法 

分 类 号：R575.3[医药卫生—消化系统] R512.62[医药卫生—内科学]