肥胖对HBV相关慢加急性肝衰竭和失代偿性肝硬化患者疾病严重程度和短期预后的影响  

Effects of obesity on the severity and mortality in patients with HBV-ACLF and decompensated cirrhosis:A retrospective cohort study

作　　者：莫瑞东[1] 章正兰 殷荣坤 周艳梅 王月[5] 尹朋博 张辰溪 付豪爽 钱聪 项晓刚[1] 谢青[1] MO Rui-dong;ZHANG Zheng-lan;YIN Rong-kun;ZHOU Yan-mei;WANG Yue;YIN Peng-bo;ZHANG Chen-xi;FU Hao-shuang;QIAN Cong;XIANG Xiao-gang;XIE Qing(Department of Infectious Diseases,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Infectious Diseases,Shanghai Pudong Hospital,Fudan University,Shanghai 201399,China;Department of Infectious Diseases,Tongren Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200050,China;Department of Infectious Diseases,the people's Hospital of Xingan,Guangxi Zhuang Autonomous region 541399,China;Department of Infectious Diseases,The Affiliated Infectious Diseases Hospital of Soochow University,Jiangsu 215006,China;Department of Infectious Diseases,Luohe Central Hospital,Henan 462005,China)

机构地区：[1]上海交通大学医学院附属瑞金医院感染科,200025 [2]复旦大学附属上海浦东医院感染科 [3]上海交通大学医学院附属同仁医院感染科 [4]广西壮族自治区桂林市兴安县人民医院感染科 [5]苏州大学附属传染病医院感染科 [6]河南省漯河市中心医院感染科

出　　处：《肝脏》2022年第7期742-747,755,共7页Chinese Hepatology

基　　金：国家自然科学基金资助项目(81900527,82070604,81770587,81970544);上海市青年科技英才杨帆计划(19YF1429200);国家“十三五”科技重大专项项目(2017ZX10203201-008,2018ZX09201016-003-001,2017ZX10202202-005-004);上海市临床重点专科项目(shslczdzk01103)。

摘　　要：目的评估肥胖对HBV相关慢加急性肝衰竭(HBV-ACLF)和失代偿性肝硬化患者疾病严重程度和短期死亡率的影响。方法纳入HBV-ACLF患者93例,失代偿性肝硬化患者285例。收集基线临床资料、代谢危险因素,并随访患者90、180 d存活情况。生存分析采用Kaplan-Meier法log-rank检验,并应用cox回归比例风险模型进行多因素生存分析。结果在378例ACLF和失代偿性肝硬化患者中有146例(38.6%)存在肥胖,肥胖是主要的代谢合并症。I组肥胖患者(25≤BMI<30)发生感染的比例明显高于非肥胖患者(44.1%vs 30.6%,χ^(2)=6.37,P=0.042)。根据预后分组,非存活组肥胖占比明显高于存活组(55.8%vs 36.4%,χ^(2)=6.05,P=0.014)。多因素分析显示,肥胖与180 d死亡率呈正相关(危险比2.07,95%可信区间1.13~3.78,P=0.018)。生存分析显示,肥胖组90和180 d死亡率均显著高于无肥胖组(χ^(2)=6.17,P=0.013;χ^(2)=5.16,P=0.023)。结论肥胖是ACLF和失代偿性肝硬化患者短期死亡率增加的危险因素。合并肥胖的ACLF和失代偿性肝硬化患者应密切监测,并根据风险分层进行早期干预。Objective To investigate the effects of obesity on short-term mortality in patients with hepatitis B virus-related acute on chronic liver failure(HBV-ACLF)and decompensated cirrhosis.Methods Ninty-three patients with HBV-ACLF and 285 patients with decompensated cirrhosis admitted to our hospital were enrolled.Baseline clinical data and risk factors of metabolism were collected.The 90-day and 180-day mortality of patients was recorded.Survival analysis was performed by log-rank test and Kaplan-Meier method.Multivariate analysis of survival was performed by Cox-regression proportional hazards model.Results Among all the patients,there were 146(38.6%)cases with obesity,which was the major metabolic comorbidities.In I group(25≤BMI<30),the incidence rate of infection in patients with obesity was significantly than that in patients without obesity(44.1%vs 30.6%,χ^(2)=6.37,P=0.042).The proportion of obesity in non-survival group was significantly higher than that in survival group(55.8%vs 36.4%,χ^(2)=6.05,P=0.014).Multivariate analysis showed that obesity was positively correlated with 180-day mortality(HR 2.07,95%CI 1.13-3.78,P=0.018).The 90-day mortality and 180-day mortality of obesity group were significantly higher than those of non obesity group(χ^(2)=6.17,P=0.013;χ^(2)=5.16,P=0.023).Conclusion Obesity is a risk factor which positively correlated with short-term mortality in patients with HBV-ACLF or decompensated cirrhosis.Close monitoring and early interventions in this part patients are necessary.

关 键 词：慢加急性肝功能衰竭 乙型肝炎 肝硬化 代谢综合征 肥胖 

分 类 号：R575[医药卫生—消化系统] R589.2[医药卫生—内科学]