慢加急性乙型肝炎肝衰竭患者合并肝性脑病的相关因素分析  

Analysis of related factors in patients with acute-on-chronic hepatitis B liver failure and hepatic encephalopathy

作　　者：林建辉 陈丽霞 刘海钰 LIN Jianhui;CHEN Lixia;LIU Haiyu(Department of Liver Diseases,Mengchao Hepatobiliary Hospital of Fujian Medical University,Fuzhou 350001;Artificial Liver Center,Mengchao Hepatobiliary Hospital of Fujian Medical University;Union Medical College of Fujian Medical University,China)

机构地区：[1]福建医科大学孟超肝胆医院肝病科,福建福州350001 [2]福建医科大学孟超肝胆医院人工肝中心 [3]福建医科大学协和临床医学院

出　　处：《胃肠病学和肝病学杂志》2024年第12期1656-1660,共5页Chinese Journal of Gastroenterology and Hepatology

基　　金：福建省自然科学基金资助项目(2021J011293)。

摘　　要：目的探索慢加急性乙型肝炎肝衰竭(acute-on-chronic hepatitis B liver failure,HBV-ACLF)患者并肝性脑病(hepatic encephalopathy,HE)的相关影响因素。方法选取福建医科大学孟超肝胆医院2016年1月至2020年6月收治的334例HBV-ACLF患者,按入院时是否合并HE分为非HE组(n=280)与HE组(n=54),比较两组人口学特征、血液生化指标、凝血功能、MELD评分等,多因素逐步Logistic回归分析独立影响因素。结果纳入患者的中位年龄45.00(36.00,54.75)岁,男264例(79.04%),HE组54例(16.17%)。HE组患者的基线血TBIL、INR、血浆氨、WBC、MELD评分与合并2型糖尿病比例均显著高于非HE组,而AST、ALT均显著低于非HE组,差异有统计学意义(P<0.05);多因素逐步Logistic回归分析结果显示,INR(OR=2.08,95%CI:1.44~3.00,P<0.01)、血浆氨(OR=1.01,95%CI:1.00~1.03,P<0.01)、WBC(OR=1.19,95%CI:1.06~1.34,P<0.01)、AST(OR=1.00,95%CI:1.00~1.00,P=0.02)、合并2型糖尿病(OR=3.08,95%CI:1.24~7.66,P=0.02)为HBV-ACLF合并HE患者的独立影响因素。结论INR、血浆氨、WBC、AST、合并2型糖尿病是HBV-ACLF合并HE患者的独立影响因素,早期识别高危患者,积极防治相关危险因素,采取针对性的管理策略以改善HBV-ACLF患者的预后。Objective To explore the related influencing factors in patients with acute-on-chronic hepatitis B liver failure(HBV-ACLF)and hepatic encephalopathy(HE).Methods A total of 334 HBV-ACLF patients admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University from Jan.2016 to Jun.2020 were selected and divided into non-HE group(n=280)and HE group(n=54)according to whether they were complicated with HE at admission.The demographics,blood biochemical indicators,coagulation function,MELD score,etc.were compared between the two groups,and multi-factor stepwise Logistic regression analysis of independent influencing factors.Results The median age of the included patients was 45.00(36.00,54.75)years old,264(79.04%)were male and 54(16.17%)were in the HE group.The baseline blood TBIL,INR,plasma ammonia,WBC,MELD score and type 2 diabetes in HE group were all significantly sodium than those in the non-HE group,while the baseline blood AST,ALT and blood sodium ions were significantly lower than those in the non-HE group,and the difference was statistically significant(P<0.05).The results of multi-factor stepwise Logistic regression analysis showed that INR(OR=2.08,95%CI:1.44-3.00,P<0.01),plasma ammonia(OR=1.01,95%CI:1.00-1.03,P<0.01),WBC(OR=1.19,95%CI:1.06-1.34,P<0.01),AST(OR=1.00,95%CI:1.00-1.00,P=0.02),type 2 diabetes(OR=3.08,95%CI:1.24-7.66,P=0.02)were independent influencing factors for patients with HBV-ACLF and HE.Conclusion INR,baseline plasma ammonia,WBC,AST,and type 2 diabetes are independent influencing factors for patients with HBV-ACLF and HE.Early identification of high-risk patients and active prevention and treatment related risk factors,and adopt targeted management strategies to improve the prognosis of HBV-ACLF patients.

关 键 词：乙型肝炎病毒 慢加急性肝衰竭 肝性脑病 因素 

分 类 号：R575[医药卫生—消化系统]