伴有中/重度食管静脉曲张的慢加急性肝衰竭患者预后危险因素分析  

Influencing factors for prognosis of patients with acute-on-chronic liver failure and moderate or severe esophageal varices

作　　者：孙亚男 曾庆环 刘远志 张世斌 李鹏 武永乐 丁惠国 Sun Yanan;Zeng Qinghuan;Liu Yuanzhi(Centre of Hepatic and Digestive Diseases,You'an Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院肝病消化中心,北京市100069

出　　处：《实用肝脏病杂志》2022年第3期391-394,共4页Journal of Practical Hepatology

基　　金：国家病毒性肝炎和艾滋病等重大传染病防治专项基金资助项目(编号:2017ZX10203202-004)。

摘　　要：目的探讨影响伴有中/重度食管静脉曲张的B型和C型慢加急性肝衰竭(ACLF)患者预后的因素。方法2017年11月1日~2020年3月31日我院住院的首次诊断的ACLF患者58例,其中B型18例(31.0%),C型40例(69.0%),胃镜检查提示存在中/重度食管静脉曲张,随访6个月。应用Logistic回归分析,探讨影响生存率的独立危险因素。结果在随访的6个月内,20例(34.5%)死亡,1例行肝移植,2例失访,35例(60.3%)生存;生存组与死亡组患者在腹水量(P=0.039)、住院期间是否行硬化剂治疗(P=0.010)、临床分型(P=0.034)、肝性脑病(P=0.029)和静脉曲张程度(P=0.046)方面差异具有统计学意义(P<0.05);非条件Logistic回归分析分析腹水量(OR=9.76)、住院期间是否行硬化剂治疗(OR=19.28)和肝性脑病(OR=5.98)均是影响患者6个月生存率的独立危险因素。结论存在大量腹水、严重肝性脑病和食管静脉曲张硬化剂治疗可能严重影响ACLF患者生存,临床医生应尽快控制并发症,不推荐进行硬化剂治疗静脉曲张。Objective The aim of this study was to investigate the prognostic factors of patients with type B and type C acute-on-chronic liver failure(ACLF)and moderate or severe esophageal varices(EV).Methods The clinical materials in 58 patients with ACLF(type B in 18,and type C in 40)and moderate to severe EV between November 1,2017 and March 31,2020 in our hospital were retrospectively analyzed.All patients were followed-up for 6 months.The Logistic regression analysis was applied to explore the independent risk factors affecting the 6-month survival rate.Results At the end of six month followed-up,20 patients(34.5%)died,1 received liver transplantation,2 lost and 35(60.3%)survived;there were significant differences respect to ascites volume(P=0.039),esophageal vein sclerotherapy(EVS)(P=0.010),ACLF clinical types(P=0.034),different stages of hepatic encephalopathy(P=0.029)and degree of varices(P=0.046)between dead and survivals;the Logistic regression analysis showed that the ascites(OR=9.76),sclerotherapy during hospitalization(OR=19.28)and hepatic encephalopathy(OR=5.98)were the independent risk factors for 6-month survival rate.Conclusion The ACLF patients with massive ascites,severe hepatic encephalopathy and EVS treatment might have a poor short-term prognosis,and we do not recommend EVS for patients with ACLF at this setting.

关 键 词：慢加急性肝衰竭 食管静脉曲张 硬化剂治疗术 危险因素 预后 

分 类 号：R575.3[医药卫生—消化系统]