慢性乙型肝炎并发肝衰竭死亡危险因素的研究

摘要/Abstract

摘要： 目的探讨影响慢性乙型肝炎患者并发肝衰竭死亡的危险因素。方法回顾性分析2019年1月至2021年2月在广东省韶关市粤北人民医院接受诊治的140例慢性乙型肝炎并发肝衰竭患者的临床资料,按照患者接受内科综合治疗后是否存活分为生存组(治疗后临床症状好转,n=77)、死亡组(治疗后无效死亡,n=63)。比较两组患者各项临床资料,采用单因素和多因素Logistic回归分析影响乙型病毒性肝炎患者并发肝衰竭死亡的危险因素。结果本研究经单因素分析结果显示,病程、血氨水平、CTP评分、MELD评分、血钠水平、年龄、碱性磷酸酶水平、转氨酶水平、血清胆红素水平、凝血酶原时间、肝性脑病、肝肾综合征、消化道出血的发生对乙型病毒性肝炎患者并发肝衰竭死亡有一定影响(均P<0.05)。经进一步多因素分析结果显示,高龄、高碱性磷酸酶水平、高转氨酶水平、高血清胆红素水平、凝血酶原时间延长、肝性脑病、肝肾综合征、消化道出血的发生是影响乙型病毒性肝炎患者并发肝衰竭死亡的独立危险因素(OR=1.347、1.029、1.654、1.352、1.274、0.081、16.415、0.937,均P<0.05)。结论高龄、高碱性磷酸酶水平、高转氨酶水平、高血清总胆红素水平、凝血酶原时间延长、肝性脑病、肝肾综合征、消化道出血的发生是影响乙型病毒性肝炎患者并发肝衰竭死亡的独立危险因素。

关键词: 慢性乙型肝炎, 肝衰竭, 死亡, 预后, 危险因素

Abstract: Objective To explore the risk factors that affect the survival of chronic hepatitis B (CHB) patients complicated with liver failure. Methods The clinical data of 140 CHB patients complicated with liver failure were retrospectively analyzed. The patients were divided into a survival group (clinical symptoms improved after treatment, n=77) and a death group (death after treatment, n=63) according to whether they survived after comprehensive medical treatment. The clinical data of these two groups of patients were compared. Single and multivariate logistic regression analyses were used to identify the risk factors that affect the survival of CHB patients complicated with liver failure. Results The result of univariate analysis showed that the course of disease, blood ammonia level, CTP score, MELD score, blood sodium level, age, alkaline phosphatase level, transaminase level, serum bilirubin level, prothrombin time, the occurrence of encephalopathy, hepatorenal syndrome, and gastrointestinal hemorrhage were the factors that impact on the survival of CHB patients with liver failure (all P<0.05). Further multi-variate analysis showed that advanced age, high levels of alkaline phosphatase, transaminase, serum bilirubin, prolonged prothrombin time, the occurrences of hepatic encephalopathy, hepatorenal syndrome, and gastrointestinal hemorrhage are independent risk factors for the survival of CHB patients with liver failure (OR=1.347, 1.029, 1.654, 1.352, 1.274, 0.081, 16.415, 0.937, respectively,all P<0.05). Conclusion Old age, high levels of alkaline phosphatase, transaminase, serum total bilirubin, and prolonged prothrombin time, the occurrences of hepatic encephalopathy, hepatorenal syndrome, and gastrointestinal hemorrhage are risk factors that impact on the survival of CHB patients with liver failure.

Key words: Chronic hepatitis B, Liver failure, Death, Prognosis, Risk factors

陈姣艳, 陈斌, 曹冬容, 朱蔓然, 焦志勇, 秦永军, 夏悯馨. 慢性乙型肝炎并发肝衰竭死亡危险因素的研究[J]. 肝脏, 2021, 26(9): 994-997.

CHEN Jiao-yan, CHEN Bin, CAO Dong-rong, ZHU Man-ran, JIAO Zhi-yong, QIN Yong-jun, XIA Ming-xin. Risk factors for liver failure-related death in chronic hepatitis B patients[J]. Chinese Hepatolgy, 2021, 26(9): 994-997.

参考文献

[1] 彭思璐,刘冰,孙宏,等.HBV相关慢加急性肝衰竭患者预后及其影响因素分析.实用肝脏病杂志,2019,22:545-548.
[2] Ho JK, Tha SP, Coupland R, et al. Parvovirus B19 in an immunocompetent adult patient with acute liver failure:an under diagnosed cause of acute non-A-E viral hepatitis. Can J Gastroenterol, 2016, 19:161-162.
[3] 李子月,杨士田,吴玲玲,等.乙型肝炎病毒相关慢加急性肝衰竭患者预后危险因素分析及预后模型建立.中华传染病杂志,2019,37:737-741.
[4] 胡辉,黄贝贝,宁玲,等.HBV相关慢加急性肝衰竭患者短期预后预测模型的建立与评价.临床肝胆病杂志,2020,36:123-127.
[5] 叶晨,时佳,杨宗国,等.HBV相关慢加急性肝衰竭预后危险因素分析及解毒逐瘀汤灌肠的临床疗效.中西医结合肝病杂志,2020,30:35-38.
[6] 李铭,林伟,尚晓娟,等.平均每日血浆负荷量对人工肝治疗慢加急性肝衰竭的预后影响分析.安徽医科大学学报,2017,52:1057-1061.
[7] 甘琼萍,谭可平,陈婵,等.经血浆置换治疗乙肝相关慢加急性肝衰竭患者短期预后模型的研究.中国现代医生,2019,57:27-30.
[8] 赵东民,黄彬彬,林格.乙型肝炎病毒慢加急性肝衰竭预后的影响因素分析.临床合理用药杂志,2019,12:139-140.
[9] 刘晨瑞,李亚萍,罗森,等.HBV相关慢加急性肝衰竭患者短期预后的影响因素分析.临床肝胆病杂志,2021,37:56-62.
[10] 陈琦,黄祖雄,张冬青,等.HBV相关慢加亚急性肝衰竭患者预后因素分析.海峡预防医学杂志,2019,25:106-108.
[11] 刘添皇,邓丽红,何宗运,等.乙型肝炎肝衰竭患者预后影响因素的Logistic回归分析.湖南中医药大学学报,2016,36:552-553.
[12] 诸聪妍,卢观婷,祁婷婷,等.乙型肝炎相关慢加急性肝衰竭患者的长期预后及生存质量.南方医科大学学报,2018,38:736-741.
[13] 吴娟,贾琳,李元元,等.HBV相关慢加急性肝衰竭患者的并发症与预后分析.北京医学,2018,40:907-911.
[14] 王成成,黄芬.慢加急性(亚急性)肝衰竭及慢性肝衰竭预后危险因素分析.临床内科杂志,2015:112-115.
[15] 龚志伟,邓存良.探讨建立乙肝相关慢加急性肝衰竭预后影响因素分析的新模型.解放军医学院学报,2020,41:269-272.