糖尿病与乙型肝炎病毒相关慢加急性肝衰竭患者短期预后的关系  

Association between diabetes mellitus and short-term prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure

作　　者：马元吉[1] 杜凌遥 白浪[1] 唐红[1] Ma Yuanji;Du Lingyao;Bai Lang;Tang Hong(Center of Infectious Diseases,West China Hospital of Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院感染性疾病中心,成都3610041

出　　处：《国际流行病学传染病学杂志》2022年第5期325-329,共5页International Journal of Epidemiology and Infectious Disease

基　　金：四川大学华西医院学科卓越发展1·3·5工程项目 (ZYGD20009、ZYJC21014)。

摘　　要：目的了解糖尿病与HBV相关慢加急性肝衰竭(HBV-ACLF)患者短期预后的关系。方法自四川大学华西医院建立的"人工肝治疗临床数据库"中筛选2018—2019年期间的HBV-ACLF患者258例,收集临床资料和90 d预后信息。采用中国重症乙型病毒性肝炎研究小组(COSSH)ACLF评分估计HBV-ACLF严重程度。运用Cox比例风险模型估计糖尿病与HBV-ACLF患者短期预后的关系。结果258例HBV-ACLF患者中有25例(9.69%)合并糖尿病。合并糖尿病患者的年龄54.00(46.50,60.00)岁、90 d病死率为60.00%,均高于未合并糖尿病的HBV-ACLF患者(χ^(2)=5.53和3.92,P=0.019和0.048)。合并糖尿病组和未合并糖尿病组的COSSH ACLF评分分别为6.69(6.04,7.24)和6.37(5.84,7.01),差异无统计学意义(χ^(2)=0.71,P=0.400)。多因素Cox比例风险模型发现糖尿病[校正的风险比(aHR)=1.93,P=0.027]和白细胞计数(aHR=1.09,P<0.001)是HBV-ACLF患者90 d预后的独立危险因素,人工肝治疗次数则是独立保护因素(aHR=0.89,P=0.010)。结论合并糖尿病的HBV-ACLF患者的短期预后较差。Objective To investigate the association between diabetes mellitus and short-term prognosis in patients with HBV-related acute-on-chronic liver failure(HBV-ACLF).Methods There were 258 HBV-ACLF patients enrolled from Clinical Data of Artificial Liver Support System Therapy of West China Hospital of Sichuan University during 2018 and 2019.Clinical data and 90-day prognostic information were collected.Disease severity of HBV-ACLF was estimated by the Chinese Group on the Study of Severe Hepatitis B(COSSH)ACLF score.The Cox proportional hazards model was used to estimate the association between diabetes mellitus and 90-day prognosis in HBV-ACLF patients.Results There were 25(9.69%)HBV-ACLF patients complicated with diabetes mellitus.The age was 54.00(46.50,60.00)years old and the 90-day mortality was 60.00%in HBV-ACLF patients with diabetes mellitus,which were both higher than those in ACLF patients without diabetes mellitus(χ^(2)=5.53 and 3.92,P=0.019 and 0.048).The COSSH ACLF score in HBV-ACLF patients with diabetes mellitus was 6.69(6.04,7.24),which was similar to that in HBV-ACLF patients without diabetes mellitus[6.37(5.84-7.01),χ^(2)=0.71,P=0.400)].The diabetes mellitus[adjusted hazard ratio(aHR)=1.93,P=0.027]and white blood cell count(aHR=1.09,P<0.001)were independent risk factors for the 90-day prognosis of HBV-ACLF patients based on multivariate Cox proportional hazards model,while the sessions of artificial liver support system therapy(aHR=0.89,P=0.010)was independent protective factor.Conclusions The short-term prognosis of HBV-ACLF patients with diabetes mellitus is even worse.

关 键 词：慢加急性肝功能衰竭 乙型肝炎 糖尿病 预后 危险因素 

分 类 号：R587.1[医药卫生—内分泌] R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学]