自身免疫性肝炎慢加急性肝衰竭的临床特征及预后分析

肝脏 ›› 2023, Vol. 28 ›› Issue (2): 157-161.

自身免疫性肝炎慢加急性肝衰竭的临床特征及预后分析

徐天娇, 田华, 游绍莉, 朱冰, 吕飒

100039 北京解放军总医院第五医学中心肝病学部

收稿日期:2022-09-17 出版日期:2023-02-28 发布日期:2023-04-10
通讯作者: 吕飒,Email:lvsa@sina.com
作者简介:共同第一作者:田华
基金资助:
国家“十三五”重大专项课题(2017ZX10203201-004)

Clinical characteristics and prognosis of patients with autoimmune hepatitis -induced acute on chronic liver failure

XU Tian-jiao, TIAN Hua, YOU Shao-li, ZHU Bing, LV Sa

Division of Liver Diseases, The Fifth Medical Center of Chinese PLA General Hospital ,Beijing 100039, China

Received:2022-09-17 Online:2023-02-28 Published:2023-04-10
Contact: LV Sa, Email:lvsa@sina.com

摘要/Abstract

摘要： 目的探讨自身免疫性肝炎慢加急性肝衰竭(AIH-ACLF)的临床特征及预后。方法回顾性分析解放军总医院第五医学中心2016年1月至2020年12月收治的36例AIH-ACLF患者的临床特征。按治疗结果将患者分为好转组和无效组,比较两组患者的相关指标。t检验和秩和检验用于分类变量的数据分析,预后转归的多因素分析采用logistic回归。结果 32例女性(88.9%)均为1型AIH,且既往未曾接受过激素治疗,86.1%患者有肝硬化基础。总治疗好转率为27.8%(10/36),有2例行肝移植治疗。腹水34例(94.4%)、肝性脑病20例(55.6%),为最常见并发症。好转组与无效组患者相比,PTA较高[32.80(26.25,37.70)%比22.95(14.86,35.25)%,P=0.044],而TBil[(171.03±69.19) μmol/L比(261.23±131.00)μmol/L,P=0.012]、MELD评分[19.00(17.75,23.50)比29.00(24.25,34.25),P<0.01]较低,肝性脑病的发生率较低(20.0%比69.2%,P=0.011),应用激素治疗患者比例高(80.0%比26.9%,P=0.007)。激素治疗及MELD评分是AIH-ACLF预后转归的独立危险因素。15例(41.2%)患者接受了激素治疗,其中8例好转。好转患者从诊断到应用激素治疗的时间更短,MELD评分更低。结论 AIH-ACLF患者的预后差,是否应用激素治疗及MELD评分是AIH-ACLF预后转归的独立危险因素。早期应用激素治疗对于改善AIH-ACLF预后至关重要。

关键词: 自身免疫性肝炎, 肝衰竭, 危险因素, 预后

Abstract: Objective To investigate the clinical characteristics and prognosis of autoimmune hepatitis acute on chronic liver failure (AIH-ACLF). Methods The clinical characteristics of 36 patients with AIH-ACLF treated in our hospital from January 2016 to December 2020 were retrospectively analyzed. According to the prognosis, patients were divided into improvement group and ineffective group, and the data between the 2 groups were compared. T test and rank sum test were used to analyze the data of classified variables, Logistic regression was used for multivariate analysis. Results Among the 36 cases, 32 were female (88.89%) and the average age was 52.29 ± 16.27 years. All the cases were AIH type 1 and had never received corticosteroid therapy before, 86.1% of patients combined with liver cirrhosis. The total improvement rate was 27.8% (10 cases), and 2 cases were treated with liver transplantation. Ascitic fluid (34 cases, 94.4%) and hepatic encephalopathy (HE) (20 cases, 55.6%) were the most common complications. Compared with the ineffective group, the prothrombin activity (PTA) in the improved group was higher [32.80 (26.25～37.70)% vs 22.95 (14.86～35.25)%, P=0.044]; the total bilirubin (TBil) (171.03±69.19μmol/L vs 261.23±131.00μmol/L, P=0.012), model for end-stage liver disease (MELD) score [19.00 (17.75～23.50) vs 29.50 (24.25～34.25), P<0.001)] and the incidence of HE (20% vs 69.2%, P=0.011) was lower. The proportion of patients treated with corticosteroid therapy was high (80.0% vs 26.9%, P=0.007). Corticosteroid therapy and MELD score were independent risk factors for prognosis of AIH-ACLF. Fifteen patients (41.2%) received corticosteroid therapy, and 8 of them improved. The interval time from diagnosis to corticosteroid therapy and MELD scores of improved patients were lower. Conclusion The prognosis of patients with AIH-ACLF is poor, corticosteroid therapy and MELD score are independent risk factors for prognosis. Early corticosteroid therapy are essential for improving the prognosis of patients with AIH-ACLF.

Key words: Autoimmune hepatitis, Liver failure, Risk factors, Prognosis

徐天娇, 田华, 游绍莉, 朱冰, 吕飒. 自身免疫性肝炎慢加急性肝衰竭的临床特征及预后分析[J]. 肝脏, 2023, 28(2): 157-161.

XU Tian-jiao, TIAN Hua, YOU Shao-li, ZHU Bing, LV Sa. Clinical characteristics and prognosis of patients with autoimmune hepatitis -induced acute on chronic liver failure[J]. Chinese Hepatolgy, 2023, 28(2): 157-161.

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