HBV相关慢加急性肝衰竭出血事件预后评价及影响因素分析

摘要/Abstract

摘要： 目的分析乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者出血事件预后评价及影响因素。方法 2017年1月至2021年1月HBV-ACLF患者156例(男119例、女37例),年龄(49.2±10.3)岁。计量资料采用t检验,计数资料采用卡方检验;生存率比较采用Log-Rank检验。结果 HBV-ACLF患者中出血51例(出血组),未出血104例(未出血组)。出血组、未出血组肝硬化31例(60.8%)、36例(34.3%),差异具有统计学意义(P<0.05);出血组肌酐(Cr)、血小板(PLT)为(80.6±9.8)μmol/L、(70.5±12.4)×10⁹/L,与未出血组[(62.4±8.4)μmol/L、(102.5±22.7)×10⁹/L]比,差异具有统计学意义(P<0.05);出血组纤维蛋白原、凝血因子Ⅴ、Ⅶ及Ⅷ为(1.1±0.2)g/L、(31.6±8.7)%、(32.8±9.2)%及(192.4±32.7)%,与未出血组[(1.8±0.6)g/L、(64.8±14.7)%、(84.4±13.8)%及(118.0±26.1)%]比,差异具有统计学意义(P<0.05)。纳入患者均有效随访,随访时间3月,随访终点为患者出现HBV-AC7LF相关死亡。出血组、未出血组患者随访1月生存率为84.3%(43/51)、93.3%(98/105),差异无统计学意义(P>0.05);出血组、未出血组患者随访3月生存率为51.0%(26/51)、73.3%(77/105),差异有统计学意义(P<0.05)。随访3月后HBV-ACLF患者生存103例(生存组),死亡53例(死亡组),比较两组并发症可知,肝性脑病、肝肾综合征、电解质紊乱及多种并发症等差异有统计学意义(P<0.05)。结论 HBV-ACLF患者肝硬化、纤维蛋白原水平降低和凝血因子VII活性降低与出血并发症发生的风险增加有关,影响患者预后。治疗期间患者存在肝性脑病、肝肾综合征、电解质紊乱及多种并发症时提示预后不佳。

关键词: 乙型肝炎病毒, 慢加急性肝衰竭, 肝硬化, 纤维蛋白原

Abstract: Objective To analyze the prognosis and influencing factors of bleeding events in patients with hepatitis B virus-associated acute on chronic liver failure (HBV-ACLF).Methods One hundred and fifty-six patients with HBV-ACLF (119 males and 37 females) with an average age of (49.2±10.3) years were collected in this study From January 2017 to January 2021. Within them, 51 cases suffered from bleeding events (bleeding group) and 104 cases weren’t bleeding (non-bleeding group). Clinical data of these two groups of patients were compared. Measurement data were analyzed with T test. Counting data were analyzed with Chi-square test. The survival rates were compared by Log-Rank test.Results There were 31 cases (60.8%) of liver cirrhosis in the bleeding group and 36 cases (34.3%) of liver cirrhosis in the non-bleeding group, and the difference was statistically significant (P<0.05). Creatinine (Cr) and platelet (PLT) in the bleeding group were (80.6±9.8) mol/L and (70.5±12.4)×10⁹/L, respectively, which were significantly higher than those in the non-bleeding group [(62.4±8.4) mol/L and (102.5±22.7)×10⁹/L, P<0.05]. The fibrinogen, coagulation factors V, VII and VIII in the bleeding group were (1.1±0.2) g/L, (31.6±8.7)%, (32.8±9.2)% and (192.4±32.7)%, respectively, which were significantly higher than those in the non-bleeding group [(1.8±0.6) g/L, (64.8±14.7)%、(84.4±13.8)% and (118.0±26.1)%, respectively, P<0.05]. All patients were followed up effectively for 3 months, and the end-point of follow-up was HBV-ACLF related death. The 1-month survival rates of the bleeding group and the non-bleeding group were 84.3%(43/51) and 93.3%(98/105), respectively, without significant difference (P>0.05). The 3-month survival rates of the bleeding group and the non-bleeding group were 51.0%(26/51) and 73.3%(77/105), respectively, and the difference was statistically significant (P<0.05). After 3 months’ follow-up, 103 cases of HBV-ACLF patients survived (survival group) and 53 cases died (death group). Comparing the complications between these two groups, there were significant differences in hepatic encephalopathy, hepatorenal syndrome, electrolyte disturbance and various complications (P<0.05).Conclusion In HBV-ACLF patients, liver cirrhosis, decreased fibrinogen level and decreased coagulation factor VII activity are related to an increased risk of bleeding, which affect the prognosis of the patients. The occurrences of hepatic encephalopathy, hepatorenal syndrome, electrolyte disturbance and various complications during treatment indicated a poor prognosis.

Key words: Hepatitis B virus, Acute-on-chronic liver failure, Liver cirrhosis, Fibrinogen

李旭东, 范锡伟, 王丽, 郭振凯. HBV相关慢加急性肝衰竭出血事件预后评价及影响因素分析[J]. 肝脏, 2022, 27(1): 68-71.

LI Xu-dong, FAN Xi-wei, WANG Li, GUO Zhen-kai. An analysis of the prognosis and influencing factors on bleeding events in patients with hepatitis B virus-related acute on chronic liver failure[J]. Chinese Hepatolgy, 2022, 27(1): 68-71.

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