乙肝相关慢加急性肝衰竭患者临床短期预后因素的分析  

Analysis of clinical short-term prognostic factors in patients with hepatitis B-related acute-on-chronic liver failure

作　　者：黄敏[1] 李冬冬 刘传苗[1] HUANG Min;LI Dong-dong;LIU Chuan-miao(Department of Infection,the First Affiliated Hospital of Bengbu Medical University,Bengbu,Anhui 233004,China)

机构地区：[1]蚌埠医学院第一附属医院感染科,安徽蚌埠233004

出　　处：《中华全科医学》2021年第12期2028-2030,共3页Chinese Journal of General Practice

基　　金：安徽高校自然科学研究项目(KJ2017A247)。

摘　　要：目的探讨终末期肝病模型(MELD)评分、总胆红素、白蛋白、国际标准化比值、凝血酶原活动度与乙肝相关的慢加急性肝衰竭(ACLF)患者短期预后的关系。方法收集2018年1月—2020年12月蚌埠医学院第一附属医院感染性疾病科住院的乙肝相关ACLF患者124例,收集患者肝功能、凝血功能等相关指标数据,注意患者是否行人工肝治疗,并进行MELD评分。根据患者入院后90 d是否存活,分为存活组(68例)和死亡组(56例)。分别比较2组患者的MELD评分、总胆红素、白蛋白、国际标准化比值、凝血酶原活动度、年龄,使用logistic回归分析研究各项指标与HBV-ACLF患者预后的关系。结果存活组患者的MELD评分、国际标准化比值、总胆红素、年龄分别为(22.66±4.69)分、1.72±0.42、(281.09±94.21)μmol/L、(40.54±7.39)岁,均显著低于死亡组[(31.38±5.39)分、2.64±0.61、(360.54±130.97)μmol/L、(45.73±12.72)岁],差异均有统计学意义(均P<0.05);存活组患者白蛋白、凝血酶原活动度分别为(31.21±3.83)g/L、(35.95±11.82)%,均显著高于死亡组患者[(28.43±4.46)g/L、(29.54±12.10)%],差异均有统计学意义(均P<0.05)。Logistic回归分析显示,MELD评分高、高水平TBil、高水平INR、年龄大是ACLF患者的独立危险因素,高水平Alb、高水平PTA是ACLF患者的保护因素。结论MELD评分、总胆红素、白蛋白、国际标准化比值、凝血酶原活动度均可作为预测ACLF患者短期预后的相关指标。Objective To explore the relationship between the model for end-stage liver disease(MELD)score,total bilirubin,albumin,international normalized ratio and prothrombin activity and the prognosis in patients with hepatitis B-related acute-on-chronic liver failure(ACLF).Methods A total of 124 patients with hepatitis B-related ACLF who were admitted from January 2018 to December 2020 were collected from the Department of Infection,the First Affiliated Hospital of Bengbu Medical University.The relevant indexes of liver function and coagulation function were collected,and whether the patients were treated with artificial liver or not,and the MELD score was also evaluated.On the basis of the clinical outcome after 90-day admission,the patients were divided into the survival group and death group.Data of MELD score,total bilirubin,albumin,international normalized ratio and prothrombin activity were compared between the two groups.Logistic regression analysis was used to study the relationship between various indexes and the prognosis of HBV-ACLF patients.Results The MELD score,the international normalized ratio and the total and the ages bilirubin in the survival group were(22.66±4.69)scores,1.72±0.42 and(281.09±94.21)μmol/L and(40.54±7.39)ages,respectively,which were significantly lower than those in the death group[(31.38±5.39)scores,2.64±0.61 and(360.54±130.97)μmol/L and(45.73±12.72)ages],all of the differences were statistically significant(all P<0.05).The albumin and prothrombin activity in the survival group were(31.21±3.83)g/L and(35.95±11.82)%,respectively,which were significantly higher than those in the death group[(28.43±4.46)g/L and(29.54±12.10)%)],all of the differences were statistically significant(all P<0.05).Logistic regression analysis showed that the higher MELD score,the higher level of TBIL,the higher level of INR and the elder age were considered as independent risk factors of ACLF patients,and albumin and prothrombin activity were considered as protective factors of ACLF patients.Concl

关 键 词：终末期肝病模型评分 总胆红素 白蛋白 国际标准化比值 凝血酶原活动度 乙肝 慢加急性肝衰竭 预后 

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