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核苷和核苷酸类药物治疗慢性乙型肝炎停药后复发并进展为肝衰竭患者的临床特征及预后影响因素分析
Clinical features of HBV-related liver failure associated with recurrence after withdrawal of nucleos(t)ide analogues and influencing factors for prognosis
文章发布日期:2018年06月07日  来源:  作者:李孝楼,卓海燕,刘志强,等  点击次数:439次  下载次数:62次
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【摘要】:目的 研究接受核苷和核苷酸类抗病毒药物治疗的慢性乙型肝炎患者停药复发后进展为肝衰竭的临床特征和预后影响因素。方法 回顾性分析2014年1月-2017年12月福建医科大学孟超肝胆医院收治的40例停药复发相关肝衰竭患者的一般资料、抗病毒治疗情况、生化指标和病毒学等临床资料,根据第12周的存活情况分为存活组(n=18)和死亡组(n=22),比较两组患者的临床特征差异。正态分布的计量资料组间比较采用t检验;偏态分布的计量资料组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ2检验。应用logistic回归分析患者停药后复发并进展为肝衰竭的影响因素。结果 死亡组与存活组患者停药前中位抗病毒治疗时间、停药至复发时间比较,差异均无统计学意义(P值均>0.05);死亡组中肝硬化患者比例显著高于存活组(81.8% vs 27.8%,χ2=11.831,P=0.001)。存活组患者Alb(t=2.302)、GGT(Z=-3.671)、胆碱酯酶(Z=-2.134)水平均明显高于死亡组,TBil水平(Z=-4.241)、PT(t=-2.727)、国际标准化比值(t=-2.343)、MELD评分(t=-3.909)均明显低于死亡组(P值均<0.05)。两组慢加急性肝衰竭分级比较,差异有统计学意义(χ2=18.425,P<0.001)。logistic回归分析显示慢加急性肝衰竭分级[比值比(OR)=9.865,95%可信区间(95%CI):1.455~67.370,P=0.020]和肝硬化(OR=9.988,95%CI:2.048~48.709,P=0.004)为影响停药复发肝衰竭转归的独立危险因素。结论 停药复发相关肝衰竭病死率较高,其预后转归与抗病毒治疗方案、疗程和病毒学指标无关。有肝硬化基础、肝衰竭分级越高的患者,预后越差。肝硬化患者停药风险极大,应坚持长期乃至终生服药。
【Abstract】:Objective To investigate the clinical features of chronic hepatitis B (CHB) patients progressing to liver failure due to recurrence after withdrawal of nucleos(t)ide analogues and influencing factors for prognosis. Methods A retrospective analysis was performed for the clinical data of 40 patients with liver failure due to recurrence after drug withdrawal who were admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2014 to December 2017, including general information, antiviral therapy, and biochemical and virological data. According to the treatment outcome at week 12, the patients were divided into survival group with 18 patients and death group with 22 patients, and clinical features were compared between the two groups. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of continuous data with skewed distribution between groups. The chi-square test was used for comparison of categorical data between groups. The logistic regression analysis was performed to identify the influencing factors for recurrence and progression to liver failure after drug withdrawal. Results There were no significant differences between the death group and the survival group in median time of antiviral therapy and time from drug withdrawal to recurrence (P>0.05), and the death group had a significantly higher proportion of patients with liver cirrhosis than the survival group (81.8% vs 27.8%, χ2=11.831, P=0.001). Compared with the death group, the survival group had significantly higher levels of albumin (t=2.302), gamma-glutamyl transpeptidase (Z=-3.671), and cholinesterase (Z=-2.134) and significantly lower total bilirubin (Z=-4.241), prothrombin time (t=-2.727), international normalized ratio (t=-2.343), and Model for End-Stage Liver Disease score (t=-3.909) (all P<0.05). There was a significant difference in acute-on-chronic liver failure (ACLF) grade between the two groups (χ2=18.425, P<0.001). The logistic regression analysis showed that ACLF grade (odds ratio [OR]=9.865, 95% confidence interval [CI]: 1.455-67.370, P=0.020) and liver cirrhosis (OR=9.988, 95%CI: 2.048-48.709, P=0.004) were independent risk factors for the prognosis of liver failure due to recurrence after drug withdrawal. Conclusion Liver failure due to recurrence after drug withdrawal has a high mortality rate, and its prognosis is not associated with antiviral regimen, course of treatment, or virological parameters. Patients with liver cirrhosis and a higher liver failure grade tend to have poorer prognosis. Patients with liver cirrhosis have a high risk after drug withdrawal and should take the medicine for a long time or even for the whole life.
【关键字】:肝炎,乙型,慢性;肝功能衰竭;抗病毒药;复发;危险因素
【Key words】:hepatitis B, chronic; liver failure; antiviral agents; recurrence; risk factors
【引证本文】:LI XL, ZHUO HY, LIU ZQ, et al. Clinical features of HBV-related liver failure associated with recurrence after withdrawal of nucleos(t)ide analogues and influencing factors for prognosis[J]. J Clin Hepatol, 2018, 34(7): 1423-1427. (in Chinese)
李孝楼, 卓海燕, 刘志强, 等. 核苷和核苷酸类药物治疗慢性乙型肝炎停药后复发并进展为肝衰竭患者的临床特征及预后影响因素分析[J]. 临床肝胆病杂志, 2018, 34(7): 1423-1427.

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