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血氨与HBV相关慢加急性肝衰竭患者90天预后的关系
Association between blood ammonia and 90-day prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure
文章发布日期:2019年05月13日  来源:  作者:童晶晶,穆秀颖,许祥,等  点击次数:290次  下载次数:79次

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【摘要】:目的探讨基线血氨(BLA)与HBV相关慢加急性肝衰竭(HBV-ACLF)患者90 d预后的关系。方法回顾性分析解放军总医院第五医学中心2013年1月-2016年12月收治入院的789例HBV-ACLF患者,研究基线BLA与HBV-ACLF患者90 d预后的关系。采用Cox回归风险模型进行多因素分析。运用Kaplan-Meier生存曲线分析不同BLA水平患者的90 d生存率,并采用log-rank检验进行比较。结果通过多个Cox多元回归模型分析,BLA与90 d HBV-ACLF患者的死亡风险呈独立正相关(完整模型:风险比=1.007,95%可信区间: 1.005~1.010,P<0.000 01)。log-rank检验显示:未合并肝性脑病(HE)的患者中,BLAlow组,BLAmid组和BLAhigh组90 d的累计病死率逐渐增高(P=0.002 3);合并HE的患者中,BLAhigh组90 d的累计病死率高于其他两组(P=0.012),而后两组患者90 d累计病死率无明显差异(P=0.18)。结论基线BLA与HBV-ACLF患者90 d死亡风险独立正相关,对治疗和预后判断有一定的临床价值。
【Abstract】:ObjectiveTo investigate the association between baseline blood ammonia (BLA) and 90-day prognosis in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (HBV-ACLF). MethodsA retrospective analysis was performed for the clinical data of 789 patients with HBV-ACLF who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from January 2013 to December 2016, and the association between baseline BLA and 90-day prognosis was analyzed. The Cox regression risk model was used for multivariate analysis. The Kaplan-Meier survival curve was used to analyze the 90-day survival rate of patients with different levels of baseline BLA, and the log-rank test was used for comparison. ResultsThe Cox multivariate regression analysis showed that BLA was independently and positively correlated with the risk of 90-day death in HBV-ACLF patients (Model 2: hazard ratio = 1.007, 95% confidence interval: 1.005-1.010, P<0.00001). The log-rank test indicated that in the patients without hepatic encephalopathy (HE), the BLAhigh group had the highest 90-day cumulative mortality rate, followed by the BLAmid group and the BLAlow group (P=0002 3); among the patients with HE, the BLAhigh group had a significantly higher 90-day cumulative mortality rate than the other two groups (P=0.012), while there was no significant difference in 90-day cumulative mortality rate between these two groups (P=0.18). ConclusionBaseline BLA is independently and positively correlated with the risk of 90-day death in HBV-ACLF patients, and it may have a certain clinical value in treatment and prognostic evaluation.
【关键字】:血氨; 乙型肝炎病毒; 慢加急性肝功能衰竭; 预后
【Key words】:blood ammonia; hepatitis B virus; acute-on-chronic liver failure; prognosis
【引证本文】:TONG JJ, MU XY, XU X, et al. Association between blood ammonia and 90-day prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure[J]. J Clin Hepatol, 2019, 35(6): 1304-1307. (in Chinese)
童晶晶, 穆秀颖, 许祥, 等. 血氨与HBV相关慢加急性肝衰竭患者90天预后的关系[J]. 临床肝胆病杂志, 2019, 35(6): 1304-1307.

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