老年乙肝相关慢加急性肝衰竭患者临床特点及进展危险因素分析  

Clinical characteristics and progression risk factors for hepatitis B-related acute-on-chronic liver failure in elderly patients

作　　者：刘磊 韩涛[1,2] 蔡均均[2] 张倩 徐佰国[1,2] 王菲 Liu Lei;Han Tao;Cai Junjun;Zhang Qian;Xu Baiguo;Wang Fei(The Third Central Clinical College of Tianjin Medical University,Tianjin 300170,China;Department of Gastroenterology and Hepatology,Tianjin Third Central Hospital Tianjin Key Laboratory of Artificial Cells Tianjin Institute of Hepatobiliary Disease Artificial Cell Engineering Technology Research Center of Public Health Ministry,Tianjin 300170,China)

机构地区：[1]天津医科大学三中心临床学院,天津300170 [2]天津市第三中心医院消化(肝病)科,天津市人工细胞重点实验室,天津市肝胆疾病研究所卫生部人工细胞工程技术研究中心,天津300170

出　　处：《中华老年医学杂志》2022年第1期51-56,共6页Chinese Journal of Geriatrics

摘　　要：目的探讨老年乙肝相关慢加急性肝衰竭患者的临床特点及其进展的相关危险因素。方法选取天津市第三中心医院符合亚太肝病学会慢加急性肝衰竭(APASL-ACLF)诊断标准的老年乙肝相关慢加急性肝衰竭(HBV-ACLF)患者168例,选取同期非老年HBV-ACLF患者176例作为对照组,记录其基线及进展情况;同时将老年组根据是否进展至欧洲肝病学会慢加急性肝衰竭(EASL-ACLF)诊断标准分为进展组和非进展组,记录其基线及进展情况;采用多因素Cox比例风险模型回归分析老年HBV-ACLF进展的独立危险因素。结果与非老年HBV-ACLF患者比较,老年患者更容易进展至EASL-ACLF诊断标准,病死率更高;多因素Cox比例风险模型回归分析结果显示,基线动脉血乳酸(HR=1.77,95%CI:1.36~2.30,P<0.01)、继发院内感染(HR=13.90,95%CI:3.73~51.87,P<0.01)、总胆红素最大变化速率(HR=1.08,95%CI:1.01~1.15,P=0.04)、终末期肝病模型评分(MELD)最大变化速率(HR=4.06,95%CI:1.53~10.77,P=0.01)以及慢性肝衰竭-序贯器官衰竭评分(CLIF-SOFA)最大变化速率(HR=12.74,95%CI:2.46~66.08,P<0.01)是老年HBV-ACLF患者进展的独立危险因素。结论老年HBV-ACLF与非老年HBV-ACLF患者比较,病情更易进展,病死率更高,应尽早识别危险因素,尽快制定治疗方案,从而进一步降低其病死率。Objective To investigate the clinical characteristics and risk factors for the progression of acute-on-chronic liver failure(ACLF)associated with hepatitis B in elderly patients.Methods A total of 168 elderly patients with hepatitis B-related acute-on-chronic liver failure(HBV-ACLF)at Tianjin Third Central Hospital who met the diagnostic criteria of the Asian Pacific Association for the Study of the Liver(APASL)-ACLF were enrolled,176 non-elderly HBV-ACLF patients served as the control group during the same period,and their baseline and progression data were recorded.At the same time,the elderly group was divided into the progressive subgroup and the non-progressive subgroup based on the diagnostic criteria of the European Society for the Study of the Liver(EASL)-ACLF,and their baseline and progression data were recorded.Independent risk factors for HBV-ACLF progression in the elderly were analyzed using multivariate Cox proportional risk model regression.Results Compared with non-elderly patients with HBV-ACLF,elderly patients were more likely to progress to meet the EASL-ACLF diagnostic criteria and have higher mortality.Multivariate Cox proportional risk model regression analysis showed that baseline arterial lactic acid levels(HR=1.77,95%CI:1.36-2.30,P<0.01),secondary nosocomial infections(HR=13.90,95%CI:3.73-51.87,P<0.01),rates of change in maximum total bilirubin(HR=1.08,95%CI:1.01-1.15,P=0.04),rates of change in maximum MELD(HR=4.06,95%CI:1.53-10.77,P=0.01)and rates of change in maximum CLIF-SOFA(HR=12.74,95%CI:2.46-66.08,P<0.01)were independent risk factors for progression of HBV-ACLF in elderly patients.Conclusions Compared with non-elderly patients,elderly patients with HBV-ACLF have more advanced disease and higher mortality.Therefore,risk factors should be identified as soon as possible and treatment plans should be formulated as soon as possible to further reduce the mortality.

关 键 词：肝炎 乙型 慢性 肝功能衰竭 急性 预后 

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