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再代偿乙型肝炎肝硬化患者发生慢加急性肝衰竭的临床特点及预后分析

刘磊 梁静 徐佰国 王菲 连佳 杨言开

引用本文:
Citation:

再代偿乙型肝炎肝硬化患者发生慢加急性肝衰竭的临床特点及预后分析

DOI: 10.3969/j.issn.1001-5256.2023.01.011
基金项目: 

天津市医学重点学科(专科)建设项目资助 (TJYXZDXK-034A);

天津市卫生健康科技项目重点学科专项资助 (TJWJ2022XK029)

伦理学声明:本研究方案于2019年1月经由天津市第三中心医院伦理委员会审批,批号:IRB2018-029-02。经患者本人或其监护人同意,签署知情同意书。
利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
作者贡献声明:刘磊负责实施研究过程,采集整理数据,统计分析数据,设计论文框架,起草论文,修订论文;梁静负责设计研究方案,整理参考文献,终审论文;徐佰国、王菲、连佳负责采集整理数据;杨言开负责提供指导性支持。
详细信息
    通信作者:

    梁静,haolele77@sina.com (ORCID: 0000-0001-5114-9030)

Clinical characteristics and prognosis of acute on chronic liver failure in patients with recompensatory hepatitis B cirrhosis

Research funding: 

Tianjin Key Medical Discipline (Specialty) Construction Project (TJYXZDXK-034A);

Tianjin Health Project (TJWJ2022XK029)

More Information
  • 摘要:   目的  探讨再代偿乙型肝炎肝硬化患者发生慢加急性肝衰竭的临床特点和预后情况。  方法  选取2013年9月—2021年9月于天津市第三中心医院住院治疗的慢加急性肝衰竭患者180例,其中乙型肝炎肝硬化再代偿患者110例,同期的代偿期乙型肝炎肝硬化患者70例作为对照组,比较其诱因、临床生化指标、并发症发生率和预后。两组间分类变量比较应用χ2检验或Fisher精确检验,对于连续性变量应用Mann-Whitney U检验。生存分析使用Kaplan-Meier方法,两组间比较采用Log-rank进行检验。  结果  再代偿组患者的肝肾综合征发生率(χ2=4.618,P=0.032)、感染发生率(χ2=6.712,P=0.010)、肌酐(Z=-4.508,P<0.001)、降钙素原(Z=-2.052,P=0.040)明显高于对照组。GGT(Z=-2.042,P=0.041)、Na(Z=-2.001,P=0.045)、空腹血糖(Z=-3.065,P=0.002)、TC(Z=-4.268,P<0.001)明显低于对照组。两组间90 d病死率(χ2=3.366,P=0.067)和1年病死率(χ2=1.893,P=0.169)比较差异均无统计学意义,经Log-rank检验,两组间90 d生存时间(χ2=2.680,P=0.100)和1年生存时间(χ2=2.074,P=0.150)比较差异均无统计学意义。  结论  与代偿期乙型肝炎肝硬化相比,再代偿后肝硬化患者发生慢加急性肝衰竭后肝肾综合征、感染及肌酐升高的发生风险增加,但90 d及1年的预后无明显差异。

     

  • 图  1  HBV-ACLF入组流程图

    Figure  1.  Flow chart of HBV-ACLF enrollment

    图  2  再代偿组与对照组90 d生存曲线的比较

    Figure  2.  Comparison of 90-day survival curves between the recompensatory group and the control group

    图  3  再代偿组与对照组1年生存曲线的比较

    Figure  3.  Comparison of one-year survival curves between the recompensatory group and the control group

    表  1  乙型肝炎肝硬化再代偿组和对照组人口学资料及入院前诱因比较

    Table  1.   Comparison of demographic data and prehospital indexes between the recompensatory hepatitis B cirrhosis group and the control group

    指标 再代偿组(n=110) 对照组(n=70) 统计值 P
    男性[例(%)] 95(86.36) 58(82.86) χ2=0.413 0.521
    年龄(岁) 49(43~58) 50(41~57) Z=-0.031 0.963
    肝内因素[例(%)]
      HBV再激活 32(29.09) 25(35.71) χ2=0.867 0.352
      酒精 8(7.27) 3(4.29) χ2=0.665 0.415
      药物 4(3.64) 5(7.14) χ2=1.107 0.293
      病毒再激活+酒精 15(13.64) 9(12.86) χ2=0.022 0.881
      病毒再激活+药物 10(9.09) 5(7.14) χ2=0.213 0.645
    肝外因素[例(%)]
      感染 9(8.18) 12(17.14) χ2=3.333 0.068
      出血 4(3.64) 4(5.71) χ2=0.435 0.510
      过度劳累 10(9.09) 5(7.14) χ2=0.213 0.645
      诱因不明 18(16.36) 2(2.86) χ2=7.901 0.005
    下载: 导出CSV

    表  2  乙型肝炎肝硬化再代偿组和对照组入院后各指标比较

    Table  2.   Comparison of indexes between the recompensatory hepatitis B cirrhosis group and the control group after admission

    指标 再代偿组(n=110) 对照组(n=70) 统计值 P
    HE[例(%)] 26(23.64) 16(22.86) χ2=0.015 0.904
    EVB[例(%)] 14(12.73) 8(11.43) χ2=0.336 0.562
    HRS[例(%)] 49(44.55) 20(28.57) χ2=4.618 0.032
    腹水[例(%)] 59(53.64) 45(64.29) χ2=1.989 0.158
    感染[例(%)] 79(71.82) 37(52.86) χ2=6.712 0.010
      呼吸道 28(25.45) 11(15.71) χ2=2.391 0.122
      原发性腹膜炎 24(21.82) 9(12.86) χ2=2.294 0.130
      泌尿道 10(9.09) 7(10.00) χ2=0.041 0.839
      肠道 8(7.27) 5(7.14) χ2=0.001 0.974
      皮肤软组织 9(8.18) 5(7.14) χ2=0.064 0.800
    ALT (U/L) 121.50(61.68~291.75) 142.05(65.50~335.50) Z=-0.847 0.397
    AST (U/L) 158.00(98.75~312.00) 169.00(96.90~360.25) Z=-0.021 0.984
    ALP (U/L) 132.50(110.75~179.25) 146.50(113.40~184.73) Z=-0.847 0.397
    GGT (U/L) 61.00(40.00~112.00) 92.00(48.68~139.15) Z=-2.042 0.041
    TP (g/L) 59.00(54.00~65.00) 61.30(53.95~67.70) Z=-1.522 0.128
    Alb (g/L) 29.25(26.00~33.00) 30.45(26.68~34.38) Z=-0.969 0.333
    GLO (g/L) 29.55(25.00~34.35) 30.35(25.43~36.00) Z=-0.638 0.523
    TBil (μmol/L) 320.35(209.88~414.95) 265.20(173.53~411.35) Z=-1.819 0.069
    ChE (U/L) 2701(1848~3668) 2978(2021~3975) Z=-1.211 0.272
    PTA (%) 35.20(28.15~41.05) 36.50(26.60~43.93) Z=-0.219 0.827
    INR 2.05(1.76~2.45) 2.16(1.78~2.79) Z=-1.068 0.285
    BUN (mmol/L) 5.65(4.15~8.08) 4.91(3.63~7.11) Z=-1.579 0.114
    Cr (μmol/L) 82.50(69.50~100.25) 65.50(53.00~80.00) Z=-4.508 <0.001
    Na (mmol/L) 134.80(130.30~137.00) 135.35(132.30~138.33) Z=-2.001 0.045
    K (mmol/L) 3.99(3.62~4.40) 4.00(3.52~4.39) Z=-0.255 0.798
    FBS (mmol/L) 4.75(4.00~6.45) 5.77(4.92~7.12) Z=-3.065 0.002
    TG (mmol/L) 0.99(0.72~1.46) 1.11(0.84~1.55) Z=-0.722 0.413
    TC (mmol/L) 1.42(1.07~2.27) 2.29(1.52~2.92) Z=-4.268 <0.001
    Hb (g/L) 119.00(103.00~134.00) 128.50(108.75~140.25) Z=-1.916 0.055
    WBC (×109/L) 6.66(4.70~9.32) 5.71(3.81~8.34) Z=-1.954 0.051
    N (%) 73.35(63.80~80.13) 71.65(62.50~78.10) Z=-0.657 0.511
    L (%) 15.88(10.18~22.18) 16.80(10.58~24.63) Z=-0.676 0.499
    PLT (×109/L) 68.50(43.00~97.50) 77.00(46.75~103.75) Z=-0.734 0.463
    NH3(μmol/L) 62(41~88) 76(49~101) Z=-1.769 0.084
    AFP (ng/mL) 28.32(4.38~143.90) 56.59(10.14~216.63) Z=-1.732 0.085
    PCT (ng/mL) 0.76(0.50~1.48) 0.50(0.34~1.08) Z=-2.052 0.040
    CRP (μg/mL) 16.84(9.50~23.85) 12.53(7.37~20.60) Z=-1.503 0.123
    Lac (mmol/L) 2.36(1.56~3.28) 2.49(2.10~3.04) Z=-0.693 0.433
    HBV DNA阳性[例(%)] 57(51.82) 39(55.71) χ2=0.261 0.610
    停药再激活[例(%)] 36(32.73) 22(31.43) χ2=0.033 0.856
    变异耐药再激活[例(%)] 14(12.73) 11(15.71) χ2=0.319 0.572
    免疫抑制剂再激活[例(%)] 7(6.36) 5(7.14) χ2=0.042 0.838
    人工肝治疗[例(%)] 38(34.55) 29(41.43) χ2=0.867 0.352
    90 d病死率[例(%)] 61(55.45) 29(41.43) χ2=3.366 0.067
    1年病死率[例(%)] 68(61.82) 36(51.43) χ2=1.893 0.169
    CTP评分 12(11~12) 11(10~12) Z=-1.232 0.263
    MELD评分 26(24~29) 25(23~29) Z=-0.904 0.366
    下载: 导出CSV
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