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)；

详细信息

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)

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