艾滋病合并HBV相关慢加急肝衰竭患者临床特征和预后分析

肝脏 ›› 2022, Vol. 27 ›› Issue (1): 63-67.

艾滋病合并HBV相关慢加急肝衰竭患者临床特征和预后分析

邓浩辉, 楼燕, 高洪波, 陈伟烈

510060 广东广州医科大学附属市八医院感染病中心(邓浩辉,楼燕,高洪波),传染病研究所(陈伟烈)

收稿日期:2021-01-14 出版日期:2022-01-31 发布日期:2022-02-11
通讯作者: 陈伟烈,Email:gz8hcwl@126.com
基金资助:
广州市卫生健康科技项目(20191A01103);广东省医学科学技术研究基金项目(B2021302)

Clinical characteristic and prognostic analysis of HBV-related acute on chronic liver failure in AIDS patients

DENG Hao-hui¹, LOU Yan¹, GAO Hong-bo¹, CHEN Wei-lie²

1. Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangdong 510060, China;
2. Institute of infectious diseases, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangdong 510060, China

Received:2021-01-14 Online:2022-01-31 Published:2022-02-11
Contact: CHEN Wei-lie,Email:gz8hcwl@126.com

摘要/Abstract

摘要： 目的对艾滋病(AIDS)合并乙型肝炎病毒相关慢加急肝衰竭(HBV-ACLF)患者的临床诊疗数据和预后特征进行分析,提高对该病的认识。方法本研究纳入2012年6月至2020年10月在广州市第八人民医院住院的22例AIDS合并HBV-ACLF和39例HBV-ACLF患者,比较两组患者各临床指标和预后的差异,并对AIDS合并HBV-ACLF好转者与治疗失败者临床数据进行初步分析,总结其特点。结果 (1)AIDS合并HBV-ACLF与HBV-ACLF组患者年龄和性别等一般资料无显著性差异(P>0.05),两组患者在发病前均未接受抗病毒治疗;血清丙氨酸氨基转移酶(Z=-2.478,P=0.013)在AIDS合并HBV-ACLF组显著低于HBV-ACLF组,HBV DNA(t=3.778,P<0.001)在AIDS合并HBV-ACLF组显著高于HBV-ACLF组,但两组患者治疗失败率无显著性差异(54.5% vs 46.1%,P=0.529),在12例AIDS合并HBV-ACLF治疗失败的患者中,2例(16.7%)患者因AIDS相关并发症(肺部感染)死亡,10例(83.3%)患者因肝衰竭及其相关并发症死亡。(2)对AIDS合并HBV-ACLF好转和治疗失败的患者临床数据进行初步分析的结果提示:好转组的年龄(Z=-2.574,P=0.009),MELD评分(t=-2.206,P=0.042),CD4⁺T淋巴细胞计数(Z=-2.374,P=0.017)显著低于治疗失败组,甲胎蛋白(Z=-2.317,P=0.020)在好转组显著高于治疗失败组。结论 AIDS合并HBV-ALCF患者预后差,应予提前干预,其肝脏炎症反应程度和预后可能与患者的免疫状态有关。

关键词: 艾滋病, 乙型病毒性肝炎, 慢加急性肝衰竭, 临床分析

Abstract: Objective To analyze the clinical characteristic and prognosis of HBV-related acute on chronic liver failure (HBV-ACLF) in patients with acquired immune deficiency syndrome (AIDS).Methods A total of 61 HBV-ACLF patients hospitalized from June 2012 to October 2020 in Guangzhou Eighth People’s Hospital were enrolled in this study, including 22 HBV-ACLF patients with AIDS and 39 patients with isolated HBV-ACLF. Clinical data were compared between these HBV-ACLF patients with AIDS and HBV-ACLF patients. In addition, the clinical data were further analyzed between treatment improve patients and treatment failure patients with HBV-ACLF and AIDS.Results (1) The baseline characteristics did not differ between HBV-ACLF patients with AIDS and isolated HBV-ACLF patients (P>0.05), All of these patients did not receive antiviral therapy before enrolled. Serum alanine aminotransferase (Z: -2.478, P=0.013) was significantly lower in HBV-ACLF patients with AIDS compared to that of HBV-ACLF patients, whereas HBV DNA (t: 3.778, P<0.001) level was significantly higher in HBV-ACLF patients with AIDS. However, the mortality rate did not differ between these two groups of patients (54.6% vs. 46.1%, P=0.529). Among the treatment failure HBV-ACLF patients with AIDS, 2 patients (16.7%) were died of severe pulmonary infection and 10 patients (83.3%) were died of liver failure or related complications. (2) The preliminary analysis results of the clinical data in HBV-ACLF patients with AIDS showed that age (Z=-2.574, P=0.009), Meld score (t: -2.206, P=0.042) and CD4⁺T cell counts (Z=-2.374, P=0.017) were significantly lower in treatment improve patients compare to those of treatment failure patients, and alpha fetoprotein (Z=-2.317, P=0.020) was significantly higher in treatment improve patients.Conclusion The ratio of treatment failure in HBV-ACLF patients with AIDS was high, and the severity of hepatic inflammation and the prognosis may be associated with the immunity status of the patients. Effective antiviral therapy should be given to HIV/HBV co-infected patients prior to HBV-ACLF occurred.

Key words: HBV-related acute on chronic liver failure, Acquired immune deficiency syndrome, Clinical analysis, Antiviral therapy

邓浩辉, 楼燕, 高洪波, 陈伟烈. 艾滋病合并HBV相关慢加急肝衰竭患者临床特征和预后分析[J]. 肝脏, 2022, 27(1): 63-67.

DENG Hao-hui, LOU Yan, GAO Hong-bo, CHEN Wei-lie. Clinical characteristic and prognostic analysis of HBV-related acute on chronic liver failure in AIDS patients[J]. Chinese Hepatolgy, 2022, 27(1): 63-67.

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