血氨与HBV相关慢加急性肝衰竭患者90天预后的关系

童晶晶; 穆秀颖; 许祥; 陈婧; 翟兴冉; 王宇; 苏海滨; 刘晓燕; 胡瑾华

doi:10.3969/j.issn.1001-5256.2019.06.024

血氨与HBV相关慢加急性肝衰竭患者90天预后的关系

DOI: 10.3969/j.issn.1001-5256.2019.06.024

1. 解放军总医院第五医学中心肝衰竭诊疗与研究中心
2. 北京大学医学部三○二临床学院
3. 解放军医学院

详细信息

中图分类号: R512.62;R575.3
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出版历程
- 收稿日期: 2019-04-11
- 出版日期: 2019-06-20

Association between blood ammonia and 90-day prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure

Liver Failure Treatment and Research Center, The Fifth Medical Center of Chinese PLA General Hospital

摘要

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）。...
- 血氨 /
- 乙型肝炎病毒 /
- 慢加急性肝功能衰竭 /
- 预后
Abstract:
Objective To 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) . Methods A 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 January2013 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. Results The 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. 0023) ; 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) . Conclusion Baseline 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.
- blood ammonia /
- hepatitis B virus /
- acute-on-chronic liver failure /
- prognosis

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