乙型肝炎肝硬化急性恶化患者慢加急性肝衰竭的发生情况及预后分析  

Analysis of occurrence and prognosis of chronic and acute liver failure in patients with acute exacerbation of hepatitis B cirrhosis

作　　者：王迎迎 WANG Yingying(Department of Infection,Songjiang District Central Hospital,Shanghai,201600,China)

机构地区：[1]上海市松江区中心医院感染科,上海201600

出　　处：《当代医学》2022年第12期31-34,共4页Contemporary Medicine

基　　金：南京医科大学科技发展基金重点项目(2016NJMUZD091)。

摘　　要：目的探讨乙型肝炎肝硬化急性恶化患者慢加急性肝衰竭的发生及预后状况。方法选取2018年1月至2020年12月处于乙型肝炎肝硬化急性恶化期的124例患者作为研究对象,按照凝血指标及黄疸情况分为A组(低凝血型,n=31)、B组(中间型,n=59)及C组(高黄疸型,n=34)。分别抽取3组空腹静脉血,检测并分析白蛋白、血肌酐、血清钠及乙肝病毒载量,并比较3组并发症发生情况。结果B组血清清蛋白(ALB)及血清钠均高于A组、C组,而血肌酐及乙肝病毒载量(HBV DNA)均低于A组、C组(P<0.05),C组血肌酐高于A组(P<0.05),C组与A组ALB、血清钠及HBV DNA比较差异无统计学意义。C组血清甲胎蛋白(AFP)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBiL)均高于A组与B组,且A组高于B组(P<0.05)。A组AST、血清钠、AFP均为急性肝衰竭情况发生的独立危险因素;C组ALT、AST、TBiL、HBV DNA为急性肝衰竭情况发生的独立危险因素(P<0.05)。B组并发症发生率均低于A组与C组(P<0.05),A组与C组并发症发生率比较差异无统计学意义。结论低凝血型与高黄疸型乙型肝炎肝硬化急性恶化患者更易出现慢加急性肝衰竭情况,且并发症发生率相对较高,严重影响预后,应依据患者不同病情采取针对性治疗措施,改善患者预后状况,提升生活质量水平。Objective To investigate the occurrence and prognosis of chronic and acute liver failure in patients with acute exacerbation of hepati-tis B cirrhosis.Methods 124 patients with acute exacerbation of hepatitis B cirrhosis from January 2018 to December 2020 were selected as the re-search subjects,they were divided into group A(hypocoagulant type,n=31),group B(intermediate type,n=59)and group C(hyperjaundice type,n=34)according to the coagulation indexes and jaundice status.The fasting venous blood was drawn from the three groups,and the albumin,serum cre-atinine,serum sodium and hepatitis B viral load were detected and compared,and the incidence of complications among the three groups was compared.Results Albumin(ALB)and serum sodium in group B were higher than those in groups A and group C,while serum creatinine and hepatitis B virus DNA(HBV DNA)were lower than those in group A and group C(P<0.05).There was no significant difference in ALB,serum sodium and HBV DNA between group C and group A.Alpha fetoprotein(AFP),alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bili-rubin(TBiL)in group C were higher than those in group A and group B,and group A was higher than group B(P<0.05).AST,serum sodium and AFP were independent risk factors for acute liver failure in group A;TBiL and HBV DNA were independent risk factors for acute liver failure in group C(P<0.05).The incidence of complications in group B was lower than that in group A and group C(P<0.05),and there was no significant difference in the incidence of complications between group A and group C.Conclusion Patients with acute deterioration of low coagulation type and high jaundice type of hepatitis B cirrhosis are more likely to suffer from and acute liver failure,and the incidence of complications is relatively high,which seriously affects the prognosis,targeted treatment measures should be taken according to different conditions of patients to improve the prog-nosis of patients and improve the quality of life at the same time.

关 键 词：乙型肝炎肝硬化 慢加急性肝衰竭 白蛋白 血肌酐 

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