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中西医结合治疗HBV相关慢加急性肝衰竭合并肝性脑病的效果分析
Clinical effect of integrated traditional Chinese and Western medicine therapy in patients with hepatitis B virus-related acute-on-chronic liver failure complicated by hepatic encephalopathy
文章发布日期:2018年03月07日  来源:  作者:宫嫚,周超,张 宁,等  点击次数:429次  下载次数:71次

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【摘要】:目的探讨中西医结合治疗HBV相关慢加急性肝衰竭(ACLF)合并肝性脑病(HE)患者8周病死率情况,分析影响其预后的独立危险因素。方法选取2012年1月-2015年2月18家医院收治的HBV-ACLF患者,采用随机对照设计分为试验组和对照组,分别给予中西医结合治疗和单纯西医综合治疗,纳入所有0周合并HE的患者125例。观察2组8周病死率情况。计量资料2组间比较采用t检验或Mann-Whitney U检验,计数资料2组间比较采用χ2检验,生存分析采用Kaplan-Meier方法及log-rank检验,危险因素分析采用Cox比例风险回归模型。结果试验组及对照组8周病死率分别为27.5%、50.0%(χ2=5.630,P=0.018),8周内中位生存时间分别为41.2 d、28.4 d,累积生存概率分别为60.4%、32.5%(χ2=6.187,P=0.013);Cox回归分析结果显示与对照组相比,试验组是HBV-ACLF合并HE患者预后的保护因素[风险比(HR)=0.424,P=0.018,95%可信区间(95%CI):0208~0.864),高TBil(HR=1.063,P=0.042,95%CI:1.002~1.128)、低PTA(HR=0.942,P=0.044,95%CI:0.890~0998)、ACLF分期晚期(HR=2737,P=0.009,95%CI:1.287~5.818)、合并消化道出血(HR=5.291,P=0.003,95%CI:1.736~16.126)是8周死亡的独立危险因素。结论中医药治疗可显著降低HBV-ACLF合并HE患者的8周病死率,提高8周生存概率,延长生存时间。TBil、PTA、疾病分期、消化道出血是该组患者的独立预后影响因素。
【Abstract】:ObjectiveTo investigate the 8-week mortality rate of patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) complicated by hepatic encephalopathy (HE) treated with integrated traditional Chinese and Western medicine therapy, as well as independent prognostic factors. MethodsA total of 125 HBV-ACLF patients with HE who were admitted to 18 hospitals from January 2012 to February 2015 were enrolled and divided into trial group and control group using a randomized controlled design. The patients in the trial group were given integrated traditional Chinese and Western medicine therapy, and those in the control group were given Western medicine therapy alone. The 8-week mortality rate was observed for both groups. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups; the chi-square test was used for comparison of categorical data between groups; the Kaplan-Meier method and the log-rank test were used for survival analysis; the Cox proportional hazards regression model was used for the analysis of risk factors. ResultsThe 8-week mortality rate was 27.5% in the trial group and 50.0% in the control group (χ2=5.630, P=0.018), the median survival time was 41.2 days in the trial group and 28.4 days in the control group, and the 8-week cumulative probability of survival was 60.4% in the trial group and 32.5% in the control group (χ2=6.187, P=0.013). The Cox regression analysis showed that compared with the control group, the trial group was a protective factor in patients with HBV-ACLF complicated by HE (hazard ratio [HR]=0.424, 95% confidence interval [CI]: 0.208-0.864, P=0.018). There were significant differences between the two groups in total bilirubin (TBil) (HR=1.063, 95%CI: 1.002-1.128, P=0.042), prothrombin activity (PTA) (HR=0.942, 95%CI: 0.890-0.998, P=0.044), ACLF stage (HR=2.737, 95%CI: 1.287-5.818, P=0.009), and the presence or absence of gastrointestinal hemorrhage (HR=5.291, 95%CI: 1.736-16.126, P=0.003). ConclusionTraditional Chinese medicine treatment can significantly reduce the 8-week mortality rate of HBV-ACLF patients with HE, increase their 8-week survival probability, and prolong survival time. TBil, PTA, ACLF stage, and gastrointestinal hemorrhage are independent prognostic factors.
【关键字】:肝功能衰竭; 肝性脑病; 肝炎病毒, 乙型; 中西医结合疗法
【Key words】:liver failure; hepatic encephalopathy; hepatitis B virus; TCM WM therapy
【引证本文】:GONG M, ZHOU C, ZHANG N, et al. Clinical effect of integrated traditional Chinese and Western medicine therapy in patients with hepatitis B virus-related acute-on-chronic liver failure complicated by hepatic encephalopathy[J]. J Clin Hepatol, 2018, 34(4): 795-800. (in Chinese)
宫嫚, 周超, 张宁, 等. 中西医结合治疗HBV相关慢加急性肝衰竭合并肝性脑病的效果分析[J]. 临床肝胆病杂志, 2018, 34(4): 795-800.

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