58例急性肝衰竭病因、临床结局及影响因素分析

摘要/Abstract

摘要： 目的回顾58例急性肝衰竭(AHF)病因、临床结局及影响因素。方法回顾2015年1月—2020年12月河南省人民医院收治AHF患者58例(男27例、女31例),年龄45(28, 66)岁。AHF诊断符合要求。依据临床结局状态分为存活组、死亡组,比较两组临床资料并行多因素分析。结果根据患者病史资料,58例AHF病例中已知病因44例、未知病因14例。已知病因包括药物源性、病毒性肝炎及其他原因,药物源性包括中草药10例(17.4%)、对乙酰氨基酚7例(12.1%)、抗菌药物4例(6.9%)、抗结核药物2例(3.4%)、抗肿瘤化疗药物及抗凝药物(苯丙香豆素)各1例(1.7%);病毒性肝炎包括HBV 5例(8.6%)、HEV 2例(3.4%)及HAV、巨细胞病毒、EB病毒各1例(1.7%);还包括肝外恶性肿瘤转移3例(5.2%)、酒精中毒2例(3.4%)、胆道严重感染2例(3.4%)及布加综合征、心力衰竭各1例(1.7%)。比较存活、死亡AHF临床资料,存活组年龄[40(28, 58)岁]显著小于死亡组[47(36, 66)岁, Z=-2.205,P<0.05];存活组≤2期、>2期肝性脑病分期为19例(86.4%)、3例(13.6%),而死亡组则为9例(25.0%)、27例(75.0%),差异具有统计学意义(χ²=20.592, P<0.05);存活组PLT、LDH、PTA、INR及动脉血氨为120(88, 225)×10⁹/L、260(124, 443)U/L、30(24, 61)%、1.8(1.2, 2.3)及71(60, 92)μmol/L,与死亡组[86(70, 148)×10⁹/L、382(227, 593)U/L、16(12, 46)%、3.4(2.5, 3.8)及152(116, 170)μmol/L]相比,差异具有统计学意义(Z=7.052, -9.450, 15.600, -23.634及-25.466, P<0.05)。对上述存在差异的数据进行logistic回归分析,结果显示年龄、肝性脑病分期、INR及动脉血氨是AHF患者死亡发生的独立危险因素(P<0.05)。结论 AHF患者病因主要包括药物源性、病毒性肝炎,分别以中草药和HBV多见。另外,年龄、肝性脑病分期、INR及动脉血氨是AHF患者死亡发生的独立危险因素。

关键词: 急性肝衰竭, 中草药, 动脉血氨

Abstract: Objective To investigate the etiology, clinical outcome and influencing factors of 58 cases with acute hepatic failure (AHF) were reviewed. Methods A total of 58 patients with AHF (27 males and 31 females) admitted to our hospital from January 2015 to December 2020 were included, with an average age of 45 (28, 66) years. According to the clinical outcome, they were divided into survival group and death group. The clinical data of the two groups were compared and analyzed by multiple factors. Results According to the medical history information of patients, 44 cases with known causes and 14 cases with unknown causes. Etiology included drug sources, viral hepatitis and other causes. Drug sources included Chinese herbal medicine (10 cases, 17.4%), acetaminophen (7 cases, 12.1%), antibacterial drugs (4 cases, 6.9%), anti-tuberculosis drugs (2 cases, 3.4%), anti-tumor chemotherapy drugs (1 case, 1.7%) and anticoagulant drugs (phenylpropyl coumarin) (1 case, 1.7%). Viral hepatitis included 5 cases of hepatitis B virus (HBV) (8.6%), 2 cases of hepatitis E virus (HEV) (3.4%) and 1 case of hepatitis A virus (HAV), cytomegalovirus and EB virus (1.7%), respectively. There were 3 cases of extrahepatic malignant tumor metastasis (5.2%), 2 cases of alcoholism (3.4%), 2 cases of severe biliary tract infection (3.4%), 1 case of Budd-Chiari syndrome and 1 case of heart failure (1.7%). Comparing the clinical data, the age of survival group [40 (28, 58) years] was significantly lower than that of death group [47 (36, 66) years, Z=-2.205, P<0.05]. In the survival group, the numbers of hepatic encephalopathy in stage ≤2 and stage > 2 were 19 cases (86.4%) and 3 cases (13.6%), while in the death group, the numbers were 9 cases (25.0%) and 27 cases (75.0%), the difference was statistically significant (χ²=20.592, P<0.05). In the survival group, platelet (PLT), low density lipoprotein (LDH), prothrombin activity (PTA), international normalized ratio(INR) and arterial blood ammonia were 120 (88, 225) ×10⁹/L, 260 (124, 443) U/L, 30 (24, 61)%, 1.8 (1.2, 2.3) and 71 (60, 92) μmol/L, compared with the death group [86 (70, 148 ) ×10⁹/L, 382 (227, 593) U/L, 16 (12, 46)%, 3.4 (2.5, 3.83) and 152 (116, 170) μmol/L], the differences were statistically significant (Z=7.052,-9.450,15.600,-23.634 and -25.466, P<0.05). Logistic regression analysis showed that age, stage of hepatic encephalopathy, INR and arterial blood ammonia were independent risk factors for death of AHF patients (P<0.05).Conclusion Etiology of patients with AHF mainly includes drug-induced and viral hepatitis, with Chinese herbal medicine and HBV as the most common causes. In addition, age, stage of hepatic encephalopathy, INR and arterial blood ammonia are independent risk factors for death of AHF patients.

Key words: Acute hepatic failure, Chinese herbal medicine, Arterial blood ammonia

赵子瑜, 牛垚飞, 王明强. 58例急性肝衰竭病因、临床结局及影响因素分析[J]. 肝脏, 2023, 28(1): 46-49.

ZHAO Zi-yu, NIU Yao-fei, WANG Ming-qiang. Analysis of etiology, clinical outcome and influencing factors of 58 cases of acute liver failure[J]. Chinese Hepatolgy, 2023, 28(1): 46-49.

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