HBV相关慢加急性肝衰竭不同分期的预后评价及影响因素分析

叶佩燕; 杨宗国; 陈晓蓉; 陆云飞

HBV相关慢加急性肝衰竭不同分期的预后评价及影响因素分析

上海市(复旦大学附属)公共卫生临床中心

基金项目:

上海市卫生局综合医院重点优势特色专病(慢性重型肝炎)建设项目(2008YSZB007)；

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中图分类号: R575.3
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出版历程
- 出版日期: 2013-04-20

Risk factors associated with prognosis of progressive stages of acute-on-chronic hepatitis B liver failure

Research funding:

摘要

摘要:
目的评价不同分期慢性HBV感染相关慢加急性肝衰竭的预后,并分析影响预后的因素。方法回顾性分析180例慢加急性肝衰竭（ACLF）患者的住院生存时间,通过Logistic回归与Cox回归分析不同预后的影响因素。结果 Kaplan-Meier显示不同分期ACLF患者累积生存率存在统计学差异（P<0.001）,早期、中期、晚期ACLF患者住院期间生存期逐渐缩短（P<0.001）;Lo-gistic多因素回归显示,有无结肠灌肠、是否并发肝性脑病和/或肝肾综合征、PTA、TBil及Alb水平是影响ACLF患者生存与否的独立因素（P<0.05或P<0.01）;Cox回归多因素分析显示,有无结肠灌肠、是否并发肝性脑病、疾病分期、WBC及CHE水平为ACLF住院生存期的独立影响因素（P<0.05或P<0.01）。结论早期ACLF患者较中晚期ACLF患者预后好,基线WBC、TBil、CHE及Alb水平为ACLF患者预后的影响因素,结肠灌肠可能对提高生存率延长生存期有积极治疗意义。
- 肝功能衰竭 /
- 肝炎病毒,乙型 /
- 存活率分析 /
- 预后
Abstract:
Objective To perform a retrospective analysis of patients with liver failure to investigate the causative factors and related risk factors that may affect patient prognosis.Methods The clinical, demographic, and laboratory data of 79 consecutive patients diagnosed with liver failure and treated at our hospital between January 2010 and January 2012 (58 males and 21 females;age range: 16-74 years old) were collected from the medical records.To identify risk factors of liver failure, the patient variables were assessed by Student's t-test (continuous variables) or Chi-squared test (categorical variables) .Multivariate logistic regression analysis was used to investigate the relation between patient outcome and independent risk factors.Results The 79 cases of liver failure were grouped according to disease severity: acute liver failure (n=6;5 died) , subacute liver failure (n=35;19 died) , and chronic liver failure (n=38;28 died) .The overall rate of death was 66%.The majority of cases (81%) were related to hepatitis B virus infection.While the three groups of liver failure severity did not show significant differences in sex, mean age, occupation, presence of potassium disorder, total bilirubin (TBil) or total cholesterol (CHO) at admission, or lowest recorded level of CHO during hospitalization, there were significant intergroup differences in highest recorded TBil level, prothrombin activity (PTA) at admission, and highest and lowest recorded PTA, and highest recorded level of CHO.Five independent risk factors were identified: the highest recorded TBil level during hospitalization, presence of infection, hepatorenal syndrome, gastrointestinal bleeding, and hepatic encephalopathy.Conclusion The major cause of liver failure in this cohort of patients was hepatitis infection, and common biomarkers of liver function, such as TBil, CHO and PTA, may indicate patients with poor prognosis despite clinical intervention.Complications should be addressed as soon as possible to try to improve a patient's potential for good outcome.
- liver failure /
- prognosis /
- risk factors /

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参考文献(15)

[1]Liver Failure and Artificial Liver Group, Chinese Society of In-fectious Diseases, Chinese Medical Association;Severe Liv-er Diseases and Artificial Liver Group, Chinese Society ofHepatology, Chinese Medical Association.Diagnostic andtreatment guideline for liver failure[J].Chin J Intern Med, 2006, 45 (12) :1053-1056. (in Chinese) 中华医学会感染病学分会肝衰竭与人工肝学组、中华医学会肝病学分会重型肝炎与人工肝学组.肝衰竭诊疗指南[J].中华内科杂志, 2006, 45 (12) :1053-1056.

[2]Laleman W, Verbeke L, Meersseman P, et al.Acute-on-chronic liver failure:current concepts on definition, patho-genesis, clinical manifestations and potential therapeutic in-terventions[J].Expert Rev Gastroenterol Hepatol, 2011, 5 (4) :523-537.

[3]Karvellas CJ, Pink F, Austin MJ, et al.Bacteremia, APACHEⅡand MELD are independent predictors of mortility in critically illpatients with acute-on-chronic liver failure[J].Hepatology, 2008, 48 (4) :515A.

[4]Zheng MH, Ye C, Shi KQ, et al.Comparison of MELD, Mayo, MESO, CTP and MELD-Na scores for predicting 3-monthmortality in patients with acute-on-chronic hepatitis B liverfailure[J].Int J Infect Dis, 2010, 14 (suppl 2) :S19.

[5]Sen S, Mohseni S, Sjodin L, et al.Baseline SOFA score andits lack of early improvement accurately predicts mortality inpatients with acute-on-chronic liver failure[J].Hepatolo-gy, 2004, 40 (4) :498A.

[6]Duan ZP, Chen Y.Recent progress and future perspectivesof liver failure diagnosis and treatment strategies[J].J ClinHepatol, 2012, 28 (10) :721-725. (in Chinese) 段钟平, 陈煜.肝衰竭诊疗:进展与展望[J].临床肝胆病杂志, 2012, 28 (10) :721-725.

[7]Ye PY, Miao H, Yang ZG, et al.Clinical observation on chro-nic severe hepatitis at early-middle stage treated with reten-tion enema of JieDu ZhuyuFang[J].Western J Tradit ChinMed, 2012, 25 (7) :1-3. (in Chinese) 叶佩燕, 苗慧, 杨宗国, 等.解毒逐瘀方保留灌肠治疗早中期慢性重型肝炎患者的临床观察[J].西部中医药, 2012, 25 (7) :1-3.

[8]Cao H, Tan SZ, Xie BH, et al.Analysis of the therapeuticeffect of elevation of retention enema of herbal drugs by se-quential colon dialysis on in patients with acute on chronichepatic failure[J].J Clin Hepatol, 2011, 27 (5) :485-487. (in Chinese) 曹慧, 谭善忠, 谢碧红, 等.结肠透析机中药高位保留灌肠治疗慢性乙型肝炎肝衰竭早期的疗效分析[J].临床肝胆病杂志, 2011, 27 (5) :485-487.

[9]Zhang DQ, Chen L, Gan QR, et al.Prognostic factors forhepatitis B acute-on-chronic liver failure[J].J Clin Hepa-tol, 2012, 28 (10) :740-743. (in Chinese) 张冬青, 陈立, 甘巧蓉, 等.乙型肝炎相关慢加急性肝衰竭患者的预后因素分析[J].临床肝胆病杂志, 2012, 28 (10) :740-743.

[10]Hong L, Ye ZY, Sun QF, et al.Relationship between com-plications and prognosis of acute-on-chronic hepatitis Bliver failure[J].Chin J Microecology, 2011, 23 (9) :829-831. (in Chinese) 洪亮, 叶志勇, 孙庆丰, 等.慢加急性乙型肝炎肝衰竭并发症与预后的关系研究[J].中国微生态学杂志, 2011, 23 (9) :829-831.

[11]Tang WL, Zhao DG, Dong ZX, et al.Prognostic risk factorsand prognosis model for liver failure[J].Infect Dis Inf, 2011, 24 (3) :159-162. (in Chinese) 汤伟亮, 赵德钢, 董志霞, 等.肝衰竭预后危险因素及预后模型建立的研究[J].传染病信息, 2011, 24 (3) :159-162.

[12]Yuen MF, Sablon E, Hui CK, et al.Prognostic factors in se-vere exacerbation of chronic hepatitis B[J].Clin Infect Dis, 2003, 36 (8) :979-984.

[13]Chien RN, Lin CH, Liaw YF, et al.The effect of lamivudinetherapy in hepatic decompensation during acute exacerbation ofchronic hepatitis B[J].J Hepatol, 2003, 38 (3) :322-327.

[14]Tsubota A, Arase Y, Suzuki Y, et al.Lamivudine monotherapyfor spontaneous severe acute exacerbation of chronic hepatitisB[J].J Gastroenterol Hepatol, 2005, 20 (3) :426-432.

[15]Cazzaniga M, Dionigi E, Gobbo G, et al.The systemic in-flammatory response syndrome in cirrhotic patients:relation-ship with their in-hospital outcome[J].J Hepatol, 2009, 51 (3) :475-482.

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