目的：探讨慢加急性乙型肝炎肝衰竭（HBV - ACLF）患者的临床特点及其预后影响因素。方法采用回顾性分析法，选取2009年1月-2012年10月在泸州医学院附属医院感染科住院治疗的HBV - ACLF患者107例作为研究对象，根据预后情况将患者分为好转组（48例）和未愈/恶化组（59例）。分析患者临床特点，并应用多因素Logistic 回归分析对预后的影响因素进行分析。结果 HBV - ACLF诱因前3位分别为：乙型肝炎（乙肝）病毒活动（占56.2%）、诱因不明（占13.1%）、乙肝病毒活动+酒精和乙肝病毒活动+劳累（均占6.5%）。各种诱因中乙肝病毒活动+丙型肝炎（丙肝）、乙肝病毒活动+艾滋病毒感染、乙肝病毒活动+药物损害诱发的肝衰竭未愈/恶化率最高（均为100.0%）。两组的年龄、清蛋白、血红蛋白、血小板计数、凝血酶原时间活动度（ PTA）、国际标准化比率（INR）、总胆红素（ TBiL）、直接胆红素（ DBiL）、血钠、终末期肝病模型评分（ MELD）、乙肝病毒 DNA 定量（HBV - DNA）、抗病毒药物使用率比较，差异有统计学意义（P <0.05）。两组患者自发性腹膜炎、肝性脑病发生率比较，差异有统计学意义（P <0.05）；而消化道出血、肝肾综合征发生率比较，差异无统计学意义（P >0.05）。多因素Logistic 回归分析显示，年龄〔 OR（95% CI）=1.062（1.012，1.115），P =0.014〕、INR 值低〔 OR（95% CI）=2.158（1.114，4.181），P =0.023〕、肝性脑病〔 OR（95% CI）=37.437（2.773，505.337），P =0.006〕是HBV - ACLF预后的独立危险因素，清蛋白水平高〔 OR（95% CI）=0.840（0.735，0.961），P =0.011〕是HBV - ACLF预后的保护因素。结论 HBV - ACLF的诱因及预后影响因素多样，临床表现复杂，需综合分析以准确评估病情及预后。%Objective To analyze the clinical features and prognostic factors of acute - on - chronic hepatitis B virus- related liver failure(HBV - ACLF). Methods 107 patients with HBV - ACLF hospitalized the Affiliated Hospital of Luzhou Medical College from Jan 2009 to Oct 2012 were enrolled and divided into improved group(48 cases)and non - improved/ deteri-oration group(59 cases)according to their prognosis. Retrospective method was used to analyze their clinical features and logistic regression analysis was used to focus on the prognostic factors. Results The first inducements of HBV - ACLF were hepatitis B vi-rus activation( accounting for 56. 2% ),no obvious causes(accounting for 13. 1% )and hepatitis B virus activation + alcohol and hepatitis B virus activation + tiredness(each accounting for 6. 5% ). The non - healing/ worsening rates of HBV - ACLF induced by hepatitis B activation + hepatitis C,hepatitis B activation + HIV infection and hepatitis B activation + drug injury were all the highest and all were 100. 0%. There were statistical differences between improved group and non - improved/ deterio-ration group in age, Alb, hemoglobin platelets, PTA, INR, TBiL, DBiL, blood Na + , MELD score, the amount of HBV - DNA and antiviral drug use rate(P < 0. 05). The differences of spontaneous bacterial peritonitis and hepatic encephalop-athy of the two groups were significant(P < 0. 05);no significant differences were found in gastrointestinal bleeding and liver -renal syndrome(P > 0. 05). Logistic regression analysis showed that age〔 OR(95% CI) = 1. 062(1. 012,1. 115),P =0. 014〕,INR values〔OR(95% CI) = 2. 158(1. 114,4. 181),P = 0. 023〕,hepatic encephalopathy〔OR(95% CI) =37. 437(2. 773,505. 337),P = 0. 006〕,Alb〔OR(95% CI) = 0. 840(0. 735,0. 961),P = 0. 011〕 were independent factors for prognosis. Conclusion Due to the diverse incentives and prognostic factors and complex clinical manifestations of HBV - ACLF,comprehensive analysis is required to accurately assess the development and prognosis.
展开▼
