慢性乙型病毒性肝炎患者发生慢加急性肝衰竭的危险因素分析  

Analysis on risk factors of chronic hepatitis B patients with chronic and acute liver failure

作　　者：孙振江 石伟珍 徐晶 过建春 谌翠容 SUN Zhenjiang;SHI Weizhen;XU Jing;GUO Jianchun;CHEN Cuirong(Department of Hepatology,Xixi Hospital of Hangzhou,Hangzhou310023,China)

机构地区：[1]杭州市西溪医院肝病科,浙江杭州310023

出　　处：《中国现代医生》2022年第2期104-107,共4页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2019KY534)。

摘　　要：目的探讨慢性乙型病毒性肝炎患者发生慢加急性肝衰竭的危险因素。方法选取2018年1月至2020年6月在杭州市西溪医院诊断治疗的慢性乙型肝炎患者130例的临床资料进行回顾性分析,130例患者中35例发生慢加急性肝衰竭,为肝衰组,95例为非肝衰组。记录患者的一般资料及临床资料,单因素及多因素分析慢性乙型病毒性肝炎患者发生慢加急性肝衰竭的危险因素。结果单因素分析结果显示,HBV DNA≥10^(7)拷贝/L,有家族史,合并感染,肝功能分级C级的患者发生肝衰竭的发生率更高,差异有统计学意义(P<0.001);肝衰竭组TBiL更高,清蛋白水平更低,国际标准化比率更高,凝血酶原活动度更低,与非肝衰组比较,差异有统计学意义(P<0.001)。多因素分析结果显示,HBV DNA≥10^(7)拷贝/L,感染,肝功能分级C级,TBiL≥171μmol/L,国际标准化比率≥1.5是慢性乙型病毒性肝炎发生慢加急性肝衰竭的独立危险因素,PTA>40%,清蛋白>20 g/L是保护因素(P<0.001)。结论慢加急性肝衰竭是慢性乙型病毒性肝炎严重的并发症,患者预后较差。影响慢性乙型病毒性肝炎患者发生慢加急性肝衰竭的因素较多,对于具有高危因素的患者,应积极预防慢加急性肝衰竭的发生。Objective To investigate the risk factors of chronic hepatitis B(CHB)patients with chronic and acute liver failure.Methods The clinical data of 130 patients with CHB diagnosed and treated in Xixi Hospital of Hangzhou from January 2018 to June 2020 were selected and analyzed retrospectively.Among the 130 patients,those who suffered from chronic and acute liver failure were divided into the liver failure group(n=35)and other patients were divided into the non-liver failure group(n=95).The general and clinical data of patients were recorded,and the risk factors of CHB patients with chronic and acute liver failure were analyzed by univariate and multivariate analysis.Results The results of univariate analysis showed that patients with HBV DNA≥107 copies/L,family history,complicated infection and liver function level C had higher incidence of liver failure,with statistically significant difference(P<0.001).Compared with the non-liver failure group,the TBiL was higher,the albumin level was lower,the international standardized ratio was higher,and the prothrombin activity was lower in the liver failure group,with statistically significant differences(P<0.001).The results of multivariate analysis showed that HBV DNA≥107 copies/L,infection,liver function level C,TBiL≥171μmol/L,international standardized ratio≥1.5 were independent risk factors for CHB with chronic and acute liver failure.And PTA>40%,albumin>20 g/L were protective factors(P<0.001).Conclusion Chronic and acute liver failure is a serious complication of CHB,and the prognosis of patients is poor.There are many factors impacting the occurrence of chronic and acute liver failure in patients with CHB.For patients with high-level risk factors,the occurrence of chronic and acute liver failure should be actively prevented.

关 键 词：慢性乙型病毒性肝炎 慢加急性肝衰竭 清蛋白 国际标准化比率 

分 类 号：R512.6[医药卫生—内科学]