慢加急性肝衰竭发病诱因及其对预后的影响

杨淑娟; 田臻; 何英利; 赵英仁; 张静; 吕恒毅; 宋红波

doi:10.3969/j.issn.1001-5256.2020.01.028

慢加急性肝衰竭发病诱因及其对预后的影响

DOI: 10.3969/j.issn.1001-5256.2020.01.028

1. 西安交通大学附属西安市第八医院肝病科
2. 西安交通大学第一附属医院感染科
3. 西安交通大学肝病研究所

基金项目:

陕西省重点研发计划项目(2017SF-243)；

详细信息

中图分类号: R575.3
计量
- 文章访问数: 1122
- HTML全文浏览量: 16
- PDF下载量: 230
- 被引次数: 0
出版历程
- 收稿日期: 2019-08-11
- 出版日期: 2020-01-20

Predisposing factors for acute-on-chronic liver failure and their influence on prognosis

Department of Hepatology,Xi'an Eighth Hospital Affiliated to Xi'an Jiaotong University

Research funding:

摘要

摘要: 目的探讨不同发病诱因所致慢加急性肝衰竭（ACLF）患者的预后差异和近10年发病诱因的变迁。方法回顾性收集2008年1月-2017年12月西安交通大学第一附属医院和西安市第八医医院住院治疗的537例ACLF患者的临床资料,包括年龄、性别、病因、发病诱因、转归（好转/死亡）,并计算28 d病死率。计量资料2组间比较采用t检验;计数资料2组间比较采用χ2检验。Cox回归分析评价不同诱因对28 d病死率的影响。结果 537例患者中HBV相关ACLF 511例（95. 16%）、HCV相关ACLF 3例（0. 56%）、酒精性肝炎相关肝衰竭2例（0. 37%）、未分型18例（3. 35%）、HBV/HCV重叠感染1例（0. 19%）,原发性胆汁性肝硬化相关ACLF 2例（0. 37%）。537例ACLF患者中,34. 8%无发病诱因,17. 1%未规范治疗,16. 0%为HBV-ACLF停用核苷类似物（NAS）,9. 7%饮酒,6. 9%合并感染,手术和应用肝损药物分别占3%。手术、感染、停用NAS诱发的ACLF 28 d病死率与无诱因患者相比,差异均有统计学意义（χ2值分别为8. 553、11...
- 慢加急性肝功能衰竭 /
- 预后 /
- 危险因素
Abstract: Objective To investigate the prognosis of patients with acute-on-chronic liver failure(ACLF) caused by different predisposing factors and the change in these factors within the past 10 years. Methods A retrospective analysis was performed for the clinical data of 537 ACLF patients who were hospitalized and treated in The First Affiliated Hospital of Xi'an Jiantong University and Xi'an Eighth Hospital from January 2008 to December 2017,including age,sex,etiology,predisposing factors,and prognosis(improvement/death),and the 28-day mortality rate was calculated. The t-test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups. A Cox regression analysis was used to evaluate the influence of different predisposing factors on 28-day mortality rate. Results Among the 537 patients with ACLF,511(95. 16%) had HBV-related ACLF,3(0. 56%) had HCV-related ACLF,2(0. 37%) had alcoholic hepatitis-related liver failure,18(3. 35%) had an unclassified type,1(0. 19%) had overlapping infection of HBV and HCV,and 2(0. 37%) had ACLF associated with primary biliary cirrhosis. Among the 537 patients with ACLF,34. 8%had no predisposing factors,17. 1% did not receive standard treatment,16% had HBV-ACLF due to the withdrawal of nucleos(t) ide analogues(NAs),9. 7% had alcohol consumption,6. 9% had infections,3% had a history of surgery,and 3% had a history of medication causing liver injury. There was a significant difference in 28-day mortality rate between the patients without predisposing factors and those with the predisposing factor of surgery,infection,or withdrawal of NAs(χ2= 8. 553,11. 351,and 4. 274,all P < 0. 05). Surgery(hazard ratio[HR]=2. 132,95% confidence interval [CI]: 1. 240-3. 664,P = 0. 006) and infection(HR = 1. 942,95% CI: 1. 262-2. 989,P =0. 003) were independent risk factors for ACLF and death in patients with chronic liver diseases. As for the change in predisposing factors in the recent 10 years,the proportion of patients with drug-induced ACLF in the last five years was significantly higher than that in the first five years(χ2= 6. 365,P < 0. 05). Conclusion ACLF patients with the predisposing factors of surgery,infection,and withdrawal of NAs have a higher 28-day mortality rate than those without these predisposing factors. Surgery and infection are independent risk factors for death in patients with ACLF. There is an increase in the proportion of patients with drug-induced ACLF in the recent 5 years.
- acute-on-chronic liver failure /
- prognosis /
- risk factors

HTML全文

参考文献(18)

[1] WLODZIMIROW KA,ESLAMI S,ABU-HANNA A,et al. A systematic review on prognostic indicators of acute on chronic liver failure and their predictive value for mortality[J]. Liver Int,2013,33(1):40-52.

[2] Chinese Society of Infectious Diseases Liver Failure and Artificial Liver Group,Hepatology Branch of Chinese Medical Association Severe Liver Disease and Artificial Liver Group. Guidelines for diagnosis and treatment of liver failure B:A2018 edition[J]. J Clin Hepatol,2019,37(1):1-9.(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病与人工肝学组．肝衰竭诊治指南(2018年版)[J]．临床肝胆病杂志，2019,37(1):1-9.

[3] BERNAL W,JALAN R,QUAGLIA A,et al. Acute-on-chronic liver failure[J]. Lancet(London,England),2015,386(10003):1576-1587.

[4] ARROYO V,MOREAU R,JALAN R,et al. Acute-on-chronic liver failure:A new syndrome that will re-classify cirrhosis[J]. J Hepatol,2015,62(1 Suppl):s131-s143.

[5] KATOONIZADEH A,LALEMAN W,VERSLYPE C,et al. Early features of acute-on-chronic alcoholic liver failure:A prospective cohort study[J]. Gut,2010,59(11):1561-1569.

[6] DING R,ZHAO H,YAN J,et al. Defination and treatment progress of acute-on-chronic liver failure[J/CD]. Chin J Liver Dis(Electronic Version),2018,10(1):1-5.(in Chinese)丁蕊，赵红，闫杰，等．慢加急性肝衰竭的定义及治疗进展[J/CD]．中国肝脏病杂志(电子版)，2018,10(1):1-5.

[7] SARIN S K,KEDARISETTY CK,ABBAS Z,et al. Acute-onchronic liver failure:Consensus recommendations of the Asian Pacific Association for the Study of the Liver(APASL)2014[J]. Hepatol Int,2014,8(4):453-471.

[8] TRIANTAFYLLOU E,WOOLLARD KJ,MCPHAIL MJW,et al.The role of monocytes and macrophages in acute and acuteon-chronic liver failure[J]. Front Immunol,2018,9:2948.

[9] ZHANG DJ,ZHOU B,HOU JL. Research progress in prognostic models of acute-on-chronic liver failure[J]. J Clin Hepatol,2018,34(6):1351-1356.(in Chinese)张东敬，周彬，侯金林．慢加急性肝衰竭预后模型的研究进展[J]．临床肝胆病杂志，2018,34(6):1351-1356.

[10] SIMONETTO DA,PICCOLO SERAFIM L,GALLO DE MORAES A,et al. Management of sepsis in patients with cirrhosis:Current evidence and practical approach[J]. Hepatology,2019,70(1):418-428.

[11] BERNARDI M,MOREAU R,ANGELI P,et al. Mechanisms of decompensation and organ failure in cirrhosis:From peripheral arterial vasodilation to systemic inflammation hypothesis[J]. J Hepatol,2015,63(5):1272-1284.

[12] SARIN SK,CHOUDHURY A. Acute-on-chronic liver failure:Terminology,mechanisms and management[J]. Nat Rev Gastroenterol Hepatol,2016,13(3):131-149.

[13] WANG C,MA DQ,LUO S,et al. Incidence of infectious complications is associated with a high mortality in patients with hepatitis B virus-related acute-on-chronic liver failure[J].World J Clin Cases,2019,7(16):2204-2216.

[14] XIE G J,ZHANG H Y,CHEN Q,et al. Changing etiologies and outcome of liver failure in Southwest China[J]. Virol J,2016,13:89.

[15] CLARIA J,STAUBER RE,COENRAAD MJ,et al. Systemic inflammation in decompensated cirrhosis:Characterization and role in acute-on-chronic liver failure[J]. Hepatology,2016,64(4):1249-1264.

[16] SOLE C,SOLA E,MORALES-RUIZ M,et al. Characterization of inflammatory response in acute-on-chronic liver failure and relationship with prognosis[J]. Sci Rep,2016,6:32341.

[17] MIKOLASEVIC I,MILIC S,RADIC M,et al. Clinical profile,natural history, and predictors of mortality in patients with acute-on-chronic liver failure(ACLF)[J]. Wien Klin Wochenschr,2015,127(7-8):283-289.

[18] LEI CJ,WU LP. Clinical types and biochemical indexes in patients with drug-induced liver failure[J/CD]. Chin J Liver Dis(Electronic Version),2018,10(1):70-73.(in Chinese)雷创杰，吴柳萍．药物性肝衰竭患者的临床分型及生物化学指标的差异[J/CD]．中国肝脏病杂志(电子版)，2018,10(1):70-73.

施引文献

资源附件(0)

访问统计