病毒性肝炎肝硬化失代偿患者再代偿对预后的影响

摘要/Abstract

摘要： 目的研究病毒性肝炎肝硬化失代偿患者再代偿对预后的影响。方法纳入2016年1月1日至2022年12月31日昆明市第三人民医院诊断为病毒性肝炎肝硬化失代偿患者734例,其中再代偿270例,持续失代偿患者464例。比较两组患者HCC发生率和病死率。Logistic回归分析评估病毒性肝炎肝硬化失代偿患者不良预后的影响因素。采用 Kaplan-Meier 法绘制生存曲线,log-rank检验生存曲线。结果持续失代偿组患者病死率13.6%(63/464),显著高于再代偿组的8.1%(22/270),差异有统计学意义(χ²=4.914,P=0.027)。再代偿患者HCC发生率8.1%(22/270),显著低于持续失代偿组的17.7%(82/464),差异有统计学意义(χ²=12.731,P<0.001)。单因素logistic回归分析显示,再代偿、病因、吸毒史、TIPS术史、年龄、PLT、TBil、DBil、TBA、Alb、PA、IL-6、PTA、APTT、CEA、CA125、PIVKA-Ⅱ、TSH、IL-1β、IgG、血氨、补体C4是病毒性肝炎肝硬化失代偿患者发生HCC及死亡的影响因素(P<0.05);多因素logistic回归分析显示,再代偿(OR=0.572,95%CI:0.374~0.874,P=0.010)、年龄(OR=1.025,95%CI:1.006~1.044,P=0.011)及PIVKA-Ⅱ(OR=1.002,95%CI:1.000~1.004,P=0.017)是病毒性肝炎肝硬化失代偿患者发生肝癌及死亡的独立影响因素。结论再代偿的发生可明显降低病毒性肝炎肝硬化失代偿患者的HCC发生率及肝病相关病死率。

关键词: 病毒性肝炎, 肝硬化, 再代偿, 肝细胞癌, 肝病相关死亡率, 不良预后

Abstract: Objective To investigate the impact of recompensation on liver disease-related mortality and the incidence of hepatocellular carcinoma (HCC) in patients with decompensated liver cirrhosis due to viral hepatitis. Methods A total of 734 patients diagnosed with decompensated liver cirrhosis due to chronic hepatitis B viral (HBV) and chronic hepatitis C viral (HCV) infection who were treated at the Third People′s Hospital of Kunming from January 1, 2016 to December 31, 2022 were collected. The patients′ data were reviewed and they were divided into a recompensation group (n=270) and a persistent decompensation group (n=464). The incidence of HCC and liver disease-related death from the time of enrollment to the end of the study was collected. Univariate logistic regression analysis was conducted to identify the factors that might affect the poor prognosis of patients with decompensated liver cirrhosis due to viral hepatitis. Variables with significant differences in the univariate comparison analysis were further screened by lasso regression to select a subset of variables without multicollinearity, which were then included in the multivariate logistic regression analysis. Survival curves were plotted using the Kaplan-Meier method and compared using the log-rank test. Results The mortality rate of patients in the persistent decompensation group was significantly higher than that in the recompensation group (13.60% vs. 8.10%, χ²=4.914, P=0.027)(63/464 vs. 22/270). The incidence of HCC in the recompensation group was significantly lower than that in the persistent decompensation group (8.10% vs. 17.70%, χ²=12.731, P<0.001)(22/270 vs. 82/464). Univariate logistic regression analysis showed that recompensation, etiology, history of drug abuse, history of TIPS surgery, age, PLT, TBil, DBil, TBA, Alb, PA, IL-6, PTA, APTT, CEA, CA125, PIVKA-II, TSH, IL-1β, IgG, blood ammonia, and complement C4 were the influencing factors of HCC risk and death risk in patients with decompensated viral hepatitis-related cirrhosis (P<0.05). Multivariate logistic regression analysis showed that recompensation (OR=0.572, 95% CI: 0.374~0.874, P=0.010), age (OR=1.025, 95% CI: 1.006~1.044, P=0.011), and PIVKA-II (OR=1.002, 95% CI: 1.000~1.004, P=0.017) were independent influencing factors for the occurrence of liver cancer and liver disease-related death in patients with decompensated viral hepatitis-related cirrhosis. Conclusion The occurrence of re-compensation can significantly reduce the incidence risk of HCC and the mortality rate in patients with decompensated liver cirrhosis caused by viral hepatitis.

Key words: Viral hepatitis, Liver cirrhosis, Recompensation, Hepatocellular carcinoma, Mortality rate, Poor prognosis

许丹青, 木唤, 张映媛, 李文彦, 撒采芬, 刘立, 李卫昆. 病毒性肝炎肝硬化失代偿患者再代偿对预后的影响[J]. 肝脏, 2026, 31(5): 619-624.

XU Dan-qing, MU Huan, ZHANG Ying-yuan, LI Wen-yan, SA Cai-fen, LIU Li, LI Wei-kun. The impact of recompensation on the prognosis of decompensated patients with viral hepatitis-related cirrhosis[J]. Chinese Hepatolgy, 2026, 31(5): 619-624.

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