肝硬化及并发症对慢加急性肝衰竭预后的影响

肝脏 ›› 2023, Vol. 28 ›› Issue (1): 37-40.

肝硬化及并发症对慢加急性肝衰竭预后的影响

翟庆慧, 刘婉姝, 田华, 李东泽, 辛绍杰

100039 北京解放军总医院第五医学中心肝病医学部

收稿日期:2022-08-30 出版日期:2023-01-31 发布日期:2023-02-21
通讯作者: 刘婉姝,Email: liuwanshu202206 @163.com
基金资助:
国家“十三五”科技重大专项(2017ZX10203201-004)

The effects of cirrhosis and related complications on the prognosis of ACLF

ZHAI Qing-hui, LIU Wan-shu, TIAN Hua, LI Dong-ze, XIN Shao-jie

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

Received:2022-08-30 Online:2023-01-31 Published:2023-02-21
Contact: LIU Wan-shu,Email: liuwanshu202206 @163.com

摘要/Abstract

摘要： 目的探讨肝硬化和慢加急性肝衰竭(acute-on-chronic liver failure, ACLF)相关并发症对ACLF疾病进展及预后的影响。方法按照中国ACLF诊断标准,对1409例患者随访观察。应用Kaplan Meier曲线及Cox回归,分析评价随访过程中组间生存的差异及与死亡相关的危险因素。采用Spearman秩相关分析ACLF类型及分期与并发症发生的相关性。结果肝硬化组ACLF 28 d及360 d非肝移植生存率分别为57.93%(460/794)、24.96%(141/565),而非肝硬化组分别为81.74%(358/438)、66.88%(210/314),χ²分别为13.618、58.631,P<0.01。360 d生存曲线Log Rank (Mantel-Cox) 检验结果显示,χ²=113.090,P<0.01。并发症数量与ACLF预后显著相关(χ²=268.642, P<0.01)。Cox多因素回归显示,肝硬化、3个及3个以上的并发症是ACLF患者死亡的独立危险因素,HR值分别为1.817(95%CI:1.460~2.260)、1.753(95%CI:1.379~2.229),P<0.01。ACLF 并发症与ACLF临床分型、ACLF分期以及MELD-Na评分呈正相关,相关系数分别为0.319、0.340、0.472,P<0.01;与凝血酶原时间活动度呈负相关,相关系数-0.358,P<0.01。结论肝硬化及并发症是影响ACLF预后的主要危险因素,并发症越多,预后越差。肝硬化及肝功能失代偿的严重程度是ACLF并发症发生的重要危险因素。

关键词: 慢加急性肝衰竭, 肝硬化, 并发症, 预后

Abstract: Objective To investigate the effects of cirrhosis and acute-on-chronic liver failure (ACLF) related complications on the prognosis of patietns with ACLF. Methods A total of 1409 patients with ACLF were enrolled and followed up. Kaplan Meier method and Cox regression were used to analyze the survival rates and risk factors among the groups. Spearman correlation analysis was used to investigate the correlation between the occurrence of complications and ACLF staging. Results The 28-day and 360-day survival rates of ACLF in the cirrhosis group were 57.93% and 24.96%, in the non-cirrhosis group were 81.74% and 66.88%, respectively (χ²=13.618, 58.631, P<0.001). The survival curve showed that the 360-day mortality of non-cirrhosis group was significantly higher than that of cirrhosis group [log rank (mantel Cox) χ²=113.090, P<0.001]. The number of complications was significantly associated with the prognosis of ACLF [log rank (mantel Cox) χ²=268.642, P<0.001]. Cox multivariate regression showed that cirrhosis and 3 or more complications were the independent risk factors for death in patients with ACLF [HR 1.817 (95%CI: 1.460-2.260), 1.753 (95%CI: 1.379-2.229), P<0.001]. The number of complications of patients with ACLF was positively correlated with the type of ACLF, ACLF stage and MELD-Na score (Correlation coefficients were 0.319, 0.340 and 0.472 respectively, P<0.001) and negatively correlated with the prothrombin time activity (Correlation coefficient was -0.358, P<0.001).Conclusion Cirrhosis and complications are the main risk factors affecting the prognosis of ACLF, with a negative correlation. The liver cirrhosis and severity of liver decompensation are the important risk factors for ACLF complications.

Key words: Acute-on-chronic liver failure, Cirrhosis, Complications, Prognosis

翟庆慧, 刘婉姝, 田华, 李东泽, 辛绍杰. 肝硬化及并发症对慢加急性肝衰竭预后的影响[J]. 肝脏, 2023, 28(1): 37-40.

ZHAI Qing-hui, LIU Wan-shu, TIAN Hua, LI Dong-ze, XIN Shao-jie. The effects of cirrhosis and related complications on the prognosis of ACLF[J]. Chinese Hepatolgy, 2023, 28(1): 37-40.

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