不同诱因慢加急性肝衰竭的临床特点及其对预后的影响

肝脏 ›› 2024, Vol. 29 ›› Issue (11): 1319-1324.

不同诱因慢加急性肝衰竭的临床特点及其对预后的影响

杨颜榕, 武羽, 李珊珊, 邹怀宾, 段钟平, 徐曼曼, 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(杨颜榕,李珊珊,邹怀宾,段钟平,陈煜),肝衰竭与人工肝治疗研究北京市重点实验室(武羽,邹怀宾,段钟平,徐曼曼)

收稿日期:2024-07-30 出版日期:2024-11-30 发布日期:2025-01-10
通讯作者: 徐曼曼,Email: xmm1903@ccmu.edu.cn;陈煜,Email: chybeyond1071@ccmu.edu.cn
作者简介:共同第一作者:武羽
基金资助:
首都卫生发展科研专项项目(首发2024-1-2181);高层次公共卫生技术人才建设项目资助(学科带头人-01-12);北京市医院管理中心“登峰”计划专项经费资助(DFL20221501)

The clinical characteristics and prognosis of acute-on-chronic liver failure induced by different precipitating factors

YANG Yan-rong¹, WU Yu², LI Shan-shan¹, ZOU Huai-bin^1,2, DUAN Zhong-ping^1,2, XU Man-man², CHEN Yu¹

1. Fourth Department of Liver Disease, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China;
2. Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing 100069, China

Received:2024-07-30 Online:2024-11-30 Published:2025-01-10
Contact: XU Man-man,Email: xmm1903@ccmu.edu.cn;CHEN Yu,Email: chybeyond1071@ccmu.edu.cn

摘要/Abstract

摘要： 目的分析不同诱发因素引起的慢加急性肝衰竭(ACLF)临床特点及预后差异,为疾病诊治提供参考。方法回顾性收集2015年1月—2023年2月就诊于首都医科大学附属北京佑安医院住院的ACLF患者的临床资料。根据发病时诱发因素,将患者分为肝内诱因ACLF和肝外诱因ACLF。分析肝内、外诱因ACLF患者的临床特征,计量资料组间比较使用t检验或Mann-Whitney U检验,计数资料组间比较使用卡方检验或Fisher精确检验,采用Log-rank检验、Landmark分析和COX比例风险模型分析肝内、外诱因ACLF患者28天、90天预后的差异及影响因素。结果共收集376例有明确诱因的ACLF患者,在以乙型肝炎为病因的ACLF患者中,HBV再激活是主要的诱因(107例, 41.6%),在非乙型肝炎ACLF患者中,感染是主要诱发因素(48例,40.3%)。根据诱因的种类,将HBV再激活、药物等肝内诱因引起的ACLF定义为肝内诱因ACLF,感染、消化道出血等肝外诱因引起的ACLF定义为肝外诱因ACLF。肝硬化患者因肝外诱因发生ACLF的比例更高,差异有统计学意义(85.7% vs 67.7%,χ²=15.411,P<0.001)。肝内、肝外诱因ACLF患者在28天和90天非移植生存率方面差异无统计学意义。根据肝病基础进行亚组分析发现,在失代偿期肝硬化患者中,肝外诱因是影响90天预后的独立影响因素。结论与非肝硬化患者相比,肝硬化基础(代偿、失代偿患者)更容易由肝外因素诱发ACLF;相较于肝内诱因,肝外诱因引起的失代偿期肝硬化ACLF患者90天病死率较低。

关键词: 慢加急性肝衰竭, 诱发因素, 临床特征, 预后

Abstract: Objective To analyze the clinical characteristics and prognostic differences of acute-on-chronic liver failure (ACLF) patients induced by different precipitating factors, in order to provide reference for disease diagnosis and treatment. Methods The clinical data of ACLF patients admitted to Beijing You’an Hospital affiliated with Capital Medical University from January 2015 to February 2023 were retrospectively analyzed. Patients were divided into hepatic-ACLF and extrahepatic-ACLF based on the precipitating factors. The clinical features of hepatic- and extrahepatic-ACLF patients were analyzed. T-tests or Mann-Whitney U tests were used for the comparison of continuous data. Chi-square tests or Fisher's exact tests were used for the comparison of categorical data. Log-rank tests, Landmark analysis, and COX proportional hazards models were used to analyze the differences and influencing factors of 28-day and 90-day prognoses between hepatic- and extrahepatic-ACLF patients. Results A total of 376 ACLF patients with clear precipitating factors were collected. Among patients with ACLF caused by hepatitis B, HBV reactivation was the main cause (107, 41.6%). Among non-hepatitis B ACLF patients, infection was the main precipitating factor (48, 40.3%). ACLF induced by HBV reactivation and drugs was defined as hepatic-ACLF, while ACLF induced by infections and gastrointestinal bleeding was defined as extrahepatic-ACLF. A higher proportion of cirrhotic patients developed ACLF due to extrahepatic factors, with a statistically significant difference (85.7% vs 67.7%, χ²=15.411, P<0.001). No statistical difference in 28-day and 90-day transplant-free survival rates between hepatic and extrahepatic-ACLF patients. By subgroup analysis based on the underlying liver disease it was revealed that extrahepatic factors were an independent influencing factor for the 90-day prognosis in patients with decompensated cirrhosis. Conclusion Compared to non-cirrhotic patients, patients with cirrhosis (compensated and decompensated) are more likely to develop ACLF induced by extrahepatic factors. Compared with intrahepatic triggers, the 90-day mortality rate of ACLF with decompensated cirrhosis caused by extrahepatic triggers is lower.

Key words: Acute-on-chronic liver failure, Precipitating events, Clinical characteristics, Prognosis

杨颜榕, 武羽, 李珊珊, 邹怀宾, 段钟平, 徐曼曼, 陈煜. 不同诱因慢加急性肝衰竭的临床特点及其对预后的影响[J]. 肝脏, 2024, 29(11): 1319-1324.

YANG Yan-rong, WU Yu, LI Shan-shan, ZOU Huai-bin, DUAN Zhong-ping, XU Man-man, CHEN Yu. The clinical characteristics and prognosis of acute-on-chronic liver failure induced by different precipitating factors[J]. Chinese Hepatolgy, 2024, 29(11): 1319-1324.

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