伴或不伴HIV/AIDS肝衰竭患者临床特征分析

摘要/Abstract

摘要： 目的探讨伴或不伴HIV/AIDS肝衰竭患者的临床特征。方法回顾性分析2017年1月至2020年8月重庆市公共卫生医疗救治中心收治的47例HIV/AIDS肝衰竭患者及同期收治的108例非HIV/AIDS肝衰竭患者的一般资料、病因、分型、实验室检查、并发症及预后。结果两组肝衰竭患者均以中年男性为主,组间性别、年龄、住院时间差异无统计学意义(P>0.05)。最常见病因均为肝炎病毒及药物,分别占(28例)59.57%、(77例)71.30%及(18例)38.30%、(24例)22.22%,由HBV导致的肝衰竭所占比例最高,分别占(27例)57.45%和(75例)69.44%。分型均以慢加急性(亚急性)肝衰竭为主,分别占(33例)70.21%及(71例)65.74%。并发症发生率最高的为感染,分别占(33例)70.21%和(61例)56.48%,以腹膜炎和肺炎为主,分别占(22例)66.67%、(42例)68.85%及(14例)42.42%、(25例)40.98%。两组的真菌感染率(16例,34.04%;4例,3.70%)、HBV规律治疗率(10例,21.28%;9例,8.33%)、无效/死亡比例(30例,63.83%;45例,41.67%)、病因中药物因素占比(18例,38.30%;24例,22.22%)、肝性脑病发生率(14例,29.79%;15例,13.89%),SCRP(40.23 mg/L,17.60 mg/L)、PCT(1.00 ng/mL;0.79 ng/mL)、PT(28.20 s;23.75 s)、INR(2.37;1.99)、Alb(25.72 g/L;28.89 g/L)、CHE(2074.64 U/L;2810.79 U/L)、CD4 T淋巴细胞(186.76/μL;390.24/μL)差异有统计学意义(P<0.05)。结论 HIV/AIDS肝衰竭患者肝脏损害更严重,肝脏合成功能更差,无效/死亡比例更高。

关键词: 肝衰竭, 人类免疫缺陷性病毒/获得性免疫缺陷综合征, 临床特征

Abstract: Objective To investigate the clinical characteristics of liver failure patients with or without Human Immunodeficiency Viral infection/Acquired Immune Deficiency Syndrome (HIV/AIDS).Methods A retrospective review of 47 cases of liver failure patients with HIV /AIDS (group 1) and 108 cases of liver failure patients without HIV/AIDS (group 2) collected from January 2017 to August 2020 was performed by analyzing their general data, etiologies, classifications, laboratory examination, complications and prognosis.Results The liver failure patients in both groups were mainly middle-aged men. There were no significant differences in gender, age and length of stay between two groups of patients (P>0.05). The most common etiology was hepatitis virus, accounting for 59.57% (28 cases) and 71.30% (77 cases) in group 1 and group 2 of patients, respectively, followed by drug that accounting for 38.30% (18 cases) and 22.22% (24 cases), respectively. The highest proportion of liver failure was caused by HBV, accounting for 57.45% (27 cases) and 69.44% (75 cases) respectively. It was mainly acute(subacute)-on-chronic according to clinical classification, accounting for 70.21% (33 cases) and 65.74% (71 cases), respectively. The highest incidence of complications was infection, accounting for 70.21% (33 cases) and 56.48% (61 cases), respectively. The infections were mainly due to peritonitis and pneumonia, accounting for 66.67% (22 cases) and 68.85% (42 cases), and 42.42% (14 cases) and 40.98% (25 cases), respectively. There were significant differences in fungal infection rate (16 cases, 34.04% vs 4 cases, 3.70%), regular treatment of HBV (10 cases, 21.28% vs 9 cases, 8.33%), ineffectiveness/mortality ratio (30 cases, 63.83% vs 45 cases, 41.67%), the proportion of drug factors in etiology (18 cases, 38.30% vs 24 cases, 22.22%), incidence of hepatic encephalopathy (14 cases, 29.79% vs 15 cases,13.89%) as well as the levels of SCRP (40.23 mg/L vs 17.60 mg/L), PCT (1.00 ng/mL vs 0.79 ng/mL), PT (28.20 s vs 23.75 s), INR (2.37 vs 1.99), ALB (25.72 g/L vs 28.89 g/L), CHE (2074.64 U/L vs 2810.79 U/L), CD4 (186.76 cells/uL vs 390.24 cells/uL) between groups (P<0.05).Conclusion Liver failure patients with HIV/AIDS have more severe liver damage, deficiency in liver synthesis function, and higher rate of ineffective treatment and deaths.

Key words: Liver failure, Human Immunodeficiency Viral infection/Acquired Immune Deficiency Syndrome, clinical features

田泽敏, 田翀. 伴或不伴HIV/AIDS肝衰竭患者临床特征分析[J]. 肝脏, 2022, 27(3): 321-324.

TIAN Ze-min, TIAN Chong. Clinical characteristics of liver failure patients with or without HIV/AIDS[J]. Chinese Hepatolgy, 2022, 27(3): 321-324.

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