慢加急性肝衰竭患者长期生存状况变化及临床特点分析

肝脏 ›› 2022, Vol. 27 ›› Issue (5): 516-520.

慢加急性肝衰竭患者长期生存状况变化及临床特点分析

康玮玮, 田辉, 冯丽丽, 刘立伟, 徐曼曼, 孔明, 段钟平, 邹正升, 陈煜

100069 北京首都医科大学附属北京佑安医院肝病中心四科,肝衰竭与人工肝治疗研究北京市重点实验室(康玮玮,冯丽丽,刘立伟,徐曼曼,孔明,段钟平,邹正升,陈煜);中国人民解放军总医院第五医学中心肝病科四/五病区(田辉,邹正升)

收稿日期:2021-11-26 出版日期:2022-05-31 发布日期:2022-07-13
通讯作者: 陈煜,Email:chybeyond1071@ccmu.edu.cn
作者简介:共同第一作者:康玮玮和田辉对本文有同等贡献
基金资助:
首都卫生发展科研专项项目(2021-1G-2181);大数据精准医疗高精尖创新中心(PXM2021_014226_000026);首都医科大学附属北京佑安医院佑安肝病艾滋病基金中青年人才孵育项目(BJYAYY-GG2019-03)。

Analysis on the long-term survival status and clinical characteristics of patients with acute-on-chronic liver failure

KANG Wei-wei¹, TIAN Hui², FENG Li-li¹, LIU Li-wei¹, XU Man-man¹, KONG Ming¹, ZOU Zheng-sheng², DUAN Zhong-ping¹, CHEN Yu¹

1. The Fourth Department of Liver Disease Center of Beijing You′an Hospital, Capital Medical University, Beijing Key Laboratory of Liver Failure And Artificial Liver Therapy,Beijing 100069, China;
2. Senior Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing 100050, China

Received:2021-11-26 Online:2022-05-31 Published:2022-07-13
Contact: CHEN Yu,Email:chybeyond1071@ccmu.edu.cn
About author:Co first author: KANG Wei-wei and TIAN Hui

摘要/Abstract

摘要： 目的分析慢加急性肝衰竭患者长期生存状况的变化。方法纳入符合ACLF诊断的患者167例,记录3个月及1年的生存状况及实验室检查结果,观察患者短期及远期生存状态变化。将ACLF患者远期(≥24周)预后转归结局分为五个等级:Ⅰ级为理想的结局,无肝硬化;Ⅱ级为满意的结局,代偿期肝硬化,表现为可逆转的肝硬化或持续代偿期的肝硬化;Ⅲ级为可接受的结局,失代偿期肝硬化,表现为失代偿期肝硬化或慢性肝衰竭;Ⅳ级为移植后存活结局;Ⅴ级为死亡结局。结果 167例ACLF患者中,年龄为45(39,53)岁,男性136例(81.4%)。肝病病因中以慢性HBV感染为主,有123例(73.7%),其他病因44例(26.3%)。基础肝病为非肝硬化患者68例(40.7%)、肝硬化患者99例(59.3%)。随访3个月肝移植后存活16例(9.6%),死亡56例(33.5%);随访1年肝移植后存活15例(9.0%),死亡67例(40.1%)。68例非肝硬化患者随访3个月时,11例(16.2%)患者仍处于非肝硬化状态,23例(33.8%)为代偿期肝硬化,14例(20.6%)为失代偿期肝硬化,5例(7.4%)行肝移植治疗后存活,15例(22.1%)死亡。随访至1年,3个月时为非肝硬化状态的11例患者中8例仍处于非肝硬化状态,1例进展至代偿期肝硬化,2例进展至失代偿期肝硬化;3个月时为代偿期肝硬化的23例患者中15例为非肝硬化,5例仍为代偿期肝硬化,3例进展至失代偿期肝硬化;3个月时为失代偿期肝硬化的14例患者中3例为非肝硬化,9例为代偿期肝硬化,2例仍为失代偿期肝硬化;3个月时肝移植后存活的5例患者中1例死亡。99例肝硬化的患者随访3个月时没有患者达到非肝硬化状态,14例(14.1%)患者为代偿期肝硬化,33例(33.3%)患者为失代偿期肝硬化,11例(11.1%)患者肝移植治疗后存活,41例(41.1%)患者死亡。随访至1年,3个月时为代偿期肝硬化的14例患者中11例仍为代偿期肝硬化,3例进展至失代偿期肝硬化;3个月时为失代偿期肝硬化的33例患者中13例为代偿期肝硬化,10例仍处于失代偿期肝硬化,1例肝移植后存活,9例死亡;3个月时肝移植后存活的11例患者中1例死亡。结论 ACLF患者短期及远期生存状态会发生变化,需要密切监测随访,积极治疗。非肝硬化的ACLF患者,经过积极治疗生存期较长,且长期存活后生存状态较好。

关键词: 慢加急性肝衰竭, 远期生存状态, 远期预后转归结局

Abstract: Objective To investigate the long-term survival status of patients with acute-on-chronic liver failure (ACLF). Methods This was a retrospective cohort study. A total of 167 patients diagnosed as ACLF were enrolled. The survival status and laboratory examination results at 3 months and 1 year after follow-up were recorded, and the changes of short-term and long-term survival status were observed. The long-term prognosis of ACLF patients (≥24 weeks) was divided into 5 grades: Grade I was an ideal outcome: without cirrhosis; Grade II was a satisfactory outcome: compensatory cirrhosis, manifested as reversible or long-term compensatory cirrhosis; Grade III was an acceptable outcome: decompensated cirrhosis, manifested as decompensated cirrhosis or chronic liver failure; Grade IV was the survival outcome after transplantation; Grade V was the death outcome. Results A total of 167 patients with ACLF were enrolled, with a median age of 45 years (39, 53) and 136 cases (81.4%) were male. The etiology of 123 cases (73.7%) was chronic hepatitis B virus (HBV) infection which was the main cause, and the other 44 cases were caused by other diseases. At baseline, 68 cases (40.7%) without liver cirrhosis, and 99 cases (59.3%) with liver cirrhosis. Three months after liver transplantation, 16 cases (9.6%) survived and 56 cases (33.5%) died. At 1 year after liver transplantation, 15 cases (9.0%) survived and 67 cases (40.1%) died. After a 3 months follow-up among the 68 patients without liver cirrhosis, 11 patients (16.2%) still without liver cirrhosis, 23 cases (33.8%) with compensated cirrhosis, 14 cases (20.6%) with decompensated cirrhosis, 5 cases (7.4%) survived after liver transplantation, and 15 cases (22.1%) died. Continue the follow-up to 1 year, among the 11 patients without cirrhosis at 3 months, 8 of which were still in non-cirrhotic state, 1 of which developed compensated cirrhosis and 2 of which developed decompensated cirrhosis; among the 23 patients with compensatory cirrhosis at 3 months, 15 of which without liver cirrhosis, 5 of which still with compensatory cirrhosis, and 3 of which developed decompensated cirrhosis; among the 14 patients with decompensated cirrhosis at 3 months, 3 of which without liver cirrhosis, 9 of which with compensated cirrhosis and 2 of which still with decompensated cirrhosis. Among the 5 patients who survived after liver transplantation at 3 months, 1 patient died. After a 3 months follow-up among the 99 patients with liver cirrhosis, all of them still with liver cirrhosis 14 patients (14.1%) with compensated cirrhosis, 33 patients (33.3%) with decompensated cirrhosis, 11 patients (11.1%) survived after liver transplantation and 41 patients (41.1%) died. Continue the follow-up to 1 year, among the 14 patients with compensatory cirrhosis at 3 months, 11 of which still with compensatory cirrhosis and 3 of which developed decompensated cirrhosis; among the 33 patients with decompensated cirrhosis at 3 months, 13 of which with compensatory cirrhosis, 10 of which still with decompensated cirrhosis, 1 of which survived after liver transplantation and 9 of which died after liver transplantation. Among the 11 patients who survived after liver transplantation at 3 months, 1 patient died. Conclusion The short-term and long-term survival status of patients with ACLF is uncertain, which requires close follow-up and active treatment. The ACLF patients without cirrhosis at baseline have a longer survival time and a better survival state after active treatment.

Key words: Acute-on-chronic liver failure, Long term survival status, Long-term prognosis and outcome

康玮玮, 田辉, 冯丽丽, 刘立伟, 徐曼曼, 孔明, 段钟平, 邹正升, 陈煜. 慢加急性肝衰竭患者长期生存状况变化及临床特点分析[J]. 肝脏, 2022, 27(5): 516-520.

KANG Wei-wei, TIAN Hui, FENG Li-li, LIU Li-wei, XU Man-man, KONG Ming, ZOU Zheng-sheng, DUAN Zhong-ping, CHEN Yu. Analysis on the long-term survival status and clinical characteristics of patients with acute-on-chronic liver failure[J]. Chinese Hepatolgy, 2022, 27(5): 516-520.

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