肥胖对HBV相关慢加急性肝衰竭和失代偿性肝硬化患者疾病严重程度和短期预后的影响

肝脏 ›› 2022, Vol. 27 ›› Issue (7): 742-747.

肥胖对HBV相关慢加急性肝衰竭和失代偿性肝硬化患者疾病严重程度和短期预后的影响

莫瑞东, 章正兰, 殷荣坤, 周艳梅, 王月, 尹朋博, 张辰溪, 付豪爽, 钱聪, 项晓刚, 谢青

200025 上海交通大学医学院附属瑞金医院感染科(莫瑞东,张辰溪,付豪爽,钱聪,项晓刚,谢青);复旦大学附属上海浦东医院感染科(章正兰);上海交通大学医学院附属同仁医院感染科(殷荣坤); 广西壮族自治区桂林市兴安县人民医院感染科(周艳梅);苏州大学附属传染病医院感染科(王月);河南省漯河市中心医院感染科(尹朋博)

收稿日期:2022-06-08 出版日期:2022-07-31 发布日期:2022-08-25
通讯作者: 章正兰,Email:zzljxygan@sina.com
基金资助:
国家自然科学基金资助项目(81900527, 82070604, 81770587,81970544);上海市青年科技英才杨帆计划(19YF1429200);国家“十三五”科技重大专项项目(2017ZX10203201-008, 2018ZX09201016-003-001, 2017ZX10202202-005-004);上海市临床重点专科项目(shslczdzk01103)

Effects of obesity on the severity and mortality in patients with HBV-ACLF and decompensated cirrhosis: A retrospective cohort study

MO Rui-dong¹, ZHANG Zheng-lan², YIN Rong-kun³, ZHOU Yan-mei⁴, WANG Yue⁵, YIN Peng-bo⁶, ZHANG Chen-xi¹, FU Hao-shuang¹, QIAN Cong¹, XIANG Xiao-gang¹, XIE Qing¹

1. Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;
2. Department of Infectious Diseases, Shanghai Pudong Hospital, Fudan University, Shanghai 201399, China;
3. Department of Infectious Diseases, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200050, China;
4. Department of Infectious Diseases, the people's Hospital of Xingan, Guangxi Zhuang Autonomous region 541399, China;
5. Department of Infectious Diseases, The Affiliated Infectious Diseases Hospital of Soochow University, Jiangsu 215006, China;
6. Department of Infectious Diseases, Luohe Central Hospital, Henan 462005, China

Received:2022-06-08 Online:2022-07-31 Published:2022-08-25
Contact: ZHANG Zheng-lan, Email:zzljxygan@sina.com

摘要/Abstract

摘要： 目的评估肥胖对HBV相关慢加急性肝衰竭(HBV-ACLF)和失代偿性肝硬化患者疾病严重程度和短期死亡率的影响。方法纳入HBV-ACLF患者93例,失代偿性肝硬化患者285例。收集基线临床资料、代谢危险因素,并随访患者90、180 d存活情况。生存分析采用Kaplan-Meier法log-rank检验,并应用cox回归比例风险模型进行多因素生存分析。结果在378例ACLF和失代偿性肝硬化患者中有146例(38.6%)存在肥胖,肥胖是主要的代谢合并症。I组肥胖患者(25 ≤BMI<30)发生感染的比例明显高于非肥胖患者(44.1% vs 30.6%,χ²=6.37, P=0.042)。根据预后分组,非存活组肥胖占比明显高于存活组(55.8% vs 36.4%,χ²=6.05, P=0.014)。多因素分析显示,肥胖与180 d死亡率呈正相关(危险比2.07, 95%可信区间1.13~3.78, P=0.018)。生存分析显示,肥胖组90 和180 d死亡率均显著高于无肥胖组(χ²=6.17, P=0.013; χ²=5.16, P=0.023)。结论肥胖是ACLF和失代偿性肝硬化患者短期死亡率增加的危险因素。合并肥胖的ACLF和失代偿性肝硬化患者应密切监测,并根据风险分层进行早期干预。

关键词: 慢加急性肝功能衰竭, 乙型肝炎, 肝硬化, 代谢综合征, 肥胖

Abstract: Objective To investigate the effects of obesity on short-term mortality in patients with hepatitis B virus-related acute on chronic liver failure (HBV-ACLF) and decompensated cirrhosis.Methods Ninty-three patients with HBV-ACLF and 285 patients with decompensated cirrhosis admitted to our hospital were enrolled. Baseline clinical data and risk factors of metabolism were collected. The 90-day and 180-day mortality of patients was recorded. Survival analysis was performed by log-rank test and Kaplan-Meier method. Multivariate analysis of survival was performed by Cox-regression proportional hazards model.Results Among all the patients, there were 146 (38.6%) cases with obesity, which was the major metabolic comorbidities. In I group (25≤BMI<30), the incidence rate of infection in patients with obesity was significantly than that in patients without obesity (44.1% vs 30.6%, χ²=6.37, P=0.042). The proportion of obesity in non-survival group was significantly higher than that in survival group (55.8% vs 36.4%, χ²=6.05, P=0.014). Multivariate analysis showed that obesity was positively correlated with 180-day mortality (HR 2.07, 95% CI 1.13-3.78, P=0.018). The 90-day mortality and 180-day mortality of obesity group were significantly higher than those of non obesity group (χ²=6.17, P=0.013; χ²=5.16, P=0.023).Conclusion Obesity is a risk factor which positively correlated with short-term mortality in patients with HBV-ACLF or decompensated cirrhosis. Close monitoring and early interventions in this part patients are necessary.

Key words: Acute on chronic live failure, Hepatitis B, Liver cirrhosis, Metabolic syndrome, Obesity

莫瑞东, 章正兰, 殷荣坤, 周艳梅, 王月, 尹朋博, 张辰溪, 付豪爽, 钱聪, 项晓刚, 谢青. 肥胖对HBV相关慢加急性肝衰竭和失代偿性肝硬化患者疾病严重程度和短期预后的影响[J]. 肝脏, 2022, 27(7): 742-747.

MO Rui-dong, ZHANG Zheng-lan, YIN Rong-kun, ZHOU Yan-mei, WANG Yue, YIN Peng-bo, ZHANG Chen-xi, FU Hao-shuang, QIAN Cong, XIANG Xiao-gang, XIE Qing. Effects of obesity on the severity and mortality in patients with HBV-ACLF and decompensated cirrhosis: A retrospective cohort study[J]. Chinese Hepatolgy, 2022, 27(7): 742-747.

参考文献

[1] Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology,2016, 64:73-84.
[2] Sarin SK, Choudhury A, Sharma MK, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update. Hepatol Int,2019, 13:353-390.
[3] D'Amico G, Morabito A, D'Amico M, et al. Clinical states of cirrhosis and competing risks. J Hepatol,2018, 68:563-576.
[4] Berzigotti A, Garcia-Tsao G, Bosch J, et al. Obesity is an independent risk factor for clinical decompensation in patients with cirrhosis. Hepatology,2011, 54:555-561.
[5] Sundaram V, Kaung A, Rajaram A, et al. Obesity is independently associated with infection in hospitalised patients with end-stage liver disease Aliment. Pharmacol Ther,2015, 42:1271-1280.
[6] Lee YB, Moon H, Lee JH, et al. Association of Metabolic Risk Factors With Risks of Cancer and All-Cause Mortality in Patients With Chronic Hepatitis B. Hepatology,2021, 73:2266-2277.
[7] Duseja A, De A, Taneja S, et al. Impact of metabolic risk factors on the severity and outcome of patients with alcohol-associated acute-on-chronic liver failure. Liver Int,2021, 41:150-157.
[8] Shi Y, Yang Y, Hu Y, et al. Acute-on-chronic liver failure precipitated by hepatic injury is distinct from that precipitated by extrahepatic insults. Hepatology,2015, 62:232-242.
[9] Chinese Society of Hepatology CMA, Xu X, Duan Z, et al. Chinese guidelines on the management of ascites and its related complications in cirrhosis. Hepatol Int, 2019, 13:1-21.
[10] Goda A, Masuyama T. Obesity and Overweight in Asian People. Circ J,2016, 80:2425-2426.
[11] Trieb M, Rainer F, Stadlbauer V, et al. HDL-related biomarkers are robust predictors of survival in patients with chronic liver failure. J Hepatol,2020, 73:113-120.
[12] Fan R, Niu J, Ma H, et al. Association of central obesity with hepatocellular carcinoma in patients with chronic hepatitis B receiving antiviral therapy. Aliment Pharmacol Ther, 2021, 54:329-338.
[13] Fischer A, Fuchs J, Stravodimos C, et al. Influence of diabetes on short-term outcome after major hepatectomy: an underestimated risk? BMC Surg,2020, 20:305.
[14] Ren H, Wang J, Gao Y, et al. Metabolic syndrome and liver-related events: a systematic review and meta-analysis BMC. Endocr Disord,2019, 19:40.
[15] Engin A. The Pathogenesis of Obesity-Associated Adipose Tissue Inflammation. Adv Exp Med Biol,2017, 960:221-245.
[16] Sundaram V, Jalan R, Ahn JC, et al. Class III obesity is a risk factor for the development of acute-on-chronic liver failure in patients with decompensated cirrhosis. J Hepatol,2018, 69:617-625.
[17] Claria J, Stauber RE, Coenraad MJ, et al. Systemic inflammation in decompensated cirrhosis: Characterization and role in acute-on-chronic liver failure. Hepatology,2016, 64:1249-1264.
[18] Ahn JC, Sundaram V. Obesity and Liver Decompensation. Clin Liver Dis (Hoboken),2019, 14:12-15.