A retrospective study on prognostic factors of HBV-related acute-on-chronic liver failure with Qi-deficiency and blood-stasis jaundice
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摘要:
目的探讨影响乙型肝炎相关慢加急性肝衰竭气虚瘀黄证患者预后的因素。方法将74例乙型肝炎相关慢加急性肝衰竭气虚瘀黄证患者根据预后结局分为好转组(25例)和死亡组(49例),用Logistic回归分析年龄、发病至就诊前时间、首诊时症状体征积分及相关生化指标[凝血酶原活动度(PTA)、总胆固醇(TC)、总胆红素(TBil)、前白蛋白(PA)]对患者预后的影响。结果好转组与死亡组对比发现,患者年龄与预后的关系不明显(P>0.05);死亡组发病至就诊前时间明显长于好转组(P<0.01),Logistic回归分析显示就诊前时间与预后呈负相关;好转组纳差、乏力、瘀斑积分明显低于死亡组,分数越高,预后越差;死亡组生化指标中TBil水平高于好转组,而PTA、TC水平低于好转组,差异具有统计学意义。结论发病至就诊前时间、纳差、乏力、瘀斑及相关生化指标均是影响乙型肝炎相关慢加急性肝衰竭气虚瘀黄证预后的重要因素。
Abstract:Objective To determine the factors affecting prognosis of hepatitis B virus (HBV) -related acute-on-chronic liver failure (ACLF) with Qi-deficiency and blood-stasis jaundice.Methods Seventy-four patients diagnosed with HBV-related ACLF and having Qi-deficiency and blood-stasis jaundice were identified for retrospective analysis and divided into two groups according to outcome: improvement (n = 25) or death (n = 49) .Patient age, days between attack and treatment, clinical symptoms and signs score, and related biochemical indexes (prothrombin activity, PTA;total cholesterol, TCH;total bilirubin, TBil) were assessed for correlation with prognosis by using logistic regression.Results There was no correlation between patients' age and prognosis (improvement group vs.death group, P > 0.05) .The period of days between attack and treatment was significantly longer for the improvement group than for the death group (P < 0.01) and logistic regression analysis indicated that the days between attack and treatment was negatively associated with prognosis.The scores for symptoms of anorexia, hypodynamia, and ecchymosis were lower in the improvement group than in the death group;in general, higher scores accompanied worse prognosis.According to logistic regression analysis, PTA, TCH, and TBil were significantly worse in the death group, with the TBIL being much higher and the PTA and TCH levels being lower than in the improvement group.Conclusion Prognostic factors of HBV-related ACLF with Qi-deficiency and blood-stasis jaundice include days between attack and treatment, anorexia, hypodynamia, ecchymosis, and related biochemical indexes.
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Key words:
- hepatitis B /
- liver failure /
- acute /
- QI-DEFICIENCY BLOOD STASIS
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