妊娠期HBV相关慢加急性肝衰竭的临床特征和转归  

Clinical features and prognosis of HBV-related acute-on-chronic liver failure in pregnancy

作　　者：纪留娟 梅雪[1] 袁伟[1] 邹颖[1] 刘玉[1] 王介非[1] 钱志平[1] JI Liujuan;MEI Xue;YUAN Wei;ZOU Ying;LIU Yu;WANG Jiefei;QIAN Zhiping(Shanghai Public Health Clinical Center Affiliated to Fudan University,Shanghai 201508,China)

机构地区：[1]上海市公共卫生临床中心,上海201508

出　　处：《临床肝胆病杂志》2022年第4期788-792,共5页Journal of Clinical Hepatology

基　　金：上海申康中心促进市级医院临床技能与临床创新能力三年行动计划项目(SHDC2020CR1037B-004);国家“十三五”科技重大专项(2018ZX10725506-002);上海市卫健委课题(20184Y0058)。

摘　　要：目的探讨妊娠期HBV相关慢加急性肝衰竭(HBV-ACLF)患者的临床特征和转归。方法回顾性分析上海市公共卫生临床中心2008年6月—2020年7月收治的26例妊娠期HBV-ACLF患者的临床资料,包括年龄、发病孕周、产次、首发症状、入院时并发症、实验室指标(WBC、Hb、PLT、ALT、TBil、Alb、SCr、MELD评分、HBsAg、HBV DNA等)、腹部超声、分娩方式、胎儿情况、治疗措施、预后转归等。正态分布的计量资料2组间比较采用t检验;非正态分布的计量资料2组间比较采用Wilcoxon秩和检验;计数资料2组间比较采用χ^(2)检验或Fisher精确检验。结果26例患者中8例均在发病后28 d内死亡,病死率达30.8%。经产妇22例,占84.6%,ACLF往往发生在妊娠晚期(20/26,76.9%),平均发病孕周为(30.9±5.8)周。HBV-ACLF临床表现不典型,首发症状常为乏力、纳差(21/26,80.8%)和尿黄(19/26,73.1%)等。死亡组的TBil(Z=-2.056,P=0.041)、凝血酶原时间(Z=-2.362,P=0.016)、国际标准化比值(Z=-2.528,P=0.009)、MELD评分(Z=-2.223,P=0.026)、首发症状至诊断时间(t=-2.468,P=0.021)、HBV DNA水平(χ^(2)=7.571,P=0.021)、肝性脑病严重程度(χ^(2)=24.775,P<0.001)、并发症发生率(χ^(2)=5.951,P=0.042)显著高于存活组,而纤维蛋白原(Z=-2.667,P=0.006)、凝血酶原活动度(Z=-2.365,P=0.016)水平明显低于存活组。结论HBV-ACLF是妊娠晚期严重并发症,经产妇多见,短期病死率极高。其早期临床表现隐匿,高MELD评分、高病毒载量和并发症的出现往往提示预后不良。Objective To investigate the clinical features and prognosis of pregnant women with HBV-related acute-on-chronic liver failure(HBV-ACLF).Methods A retrospective analysis was performed for the clinical data of 26 pregnant women with HBV-ACLF who were admitted to Shanghai Public Health Clinical Center from June 2008 to July 2020,including age,gestational weeks at disease onset,parity,initial symptoms,complications on admission,laboratory markers[white blood cell count,hemoglobin,platelet count,alanine aminotransferase,total bilirubin(TBil),albumin,serum creatinine,Model for End-Stage Liver Disease(MELD)score,HBsAg,and HBV DNA],abdominal ultrasound,mode of delivery,fetus conditions,treatment measures,and prognosis.The t-test was used for comparison of normally distributed continuous data between two groups,and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test and the Fisher’s exact test were used for comparison of categorical data between two groups.Results Among the 26 patients,8 died within 28 days after disease onset,and the mortality rate reached 30.8%.There were 22 multiparous patients,accounting for 84.6%,and HBV-ACLF often occurred in the third trimester of pregnancy(20/26,76.9%),with a mean gestational age of 30.9±5.8 weeks.HBV-ACLF often had atypical clinical manifestations,and initial symptoms included weakness,poor appetite(21/26,80.8%),and yellow urine(19/26,73.1%).Compared with the survival group,the death group had significantly higher levels of TBil(Z=-2.056,P=0.041),prothrombin time(Z=-2.362,P=0.016),international normalized ratio(Z=-2.528,P=0.009),and MELD score(Z=-2.223,P=0.026),a significantly longer time from initial symptom to diagnosis(Z=-2.468,P=0.021),significantly higher HBV DNA level(χ^(2)=7.571,P=0.021),degree of hepatic encephalopathy(χ^(2)=24.775,P<0.001),and incidence rate of complications(χ^(2)=5.951,P=0.042),and significantly lower levels of fibrinogen(Z=-2.667,P=0.006)and prothrombin time activi

关 键 词：乙型肝炎病毒 慢加急性肝功能衰竭 妊娠并发症 体征和症状 预后 

分 类 号：R714.25[医药卫生—妇产科学]