乙型肝炎代偿期和失代偿期肝硬化患者的缺铁性贫血发生率及其对临床结局的影响

摘要/Abstract

摘要： 目的分析乙型肝炎代偿期和失代偿期肝硬化患者的缺铁性贫血(IDA)发生率及其对临床结局的影响。方法回顾性收集2010年2月—2022年5月于东南大学附属中大医院无锡分院初次就诊的乙型肝炎肝硬化患者临床资料。根据肝功能Child-Pugh分级,将患者分为代偿期和失代偿期两组。统计所有患者的血清转铁蛋白和血红蛋白等实验室指标,分析IDA在两组患者中的发生率。采用卡方检验比较代偿期和失代偿期患者的IDA发生率。随访两组患者的不良结局,分析IDA对两组患者临床结局的影响。结果共纳入189例乙型肝炎肝硬化患者,男109例,女80例,年龄32~68岁。其中代偿期86例,失代偿期103例。代偿期、失代偿期患者腹水病例分别为14例(16.3%)、88例(85.4%),差异具有统计学意义(P<0.05);代偿期患者中无贫血、IDA及其他贫血原因分别为62例(72.1%)、16例(18.6%)及8例(9.3%),与失代偿期[37例(35.9%)、42例(40.8%)及24例(23.3%)]比较,差异具有统计学意义(P<0.05);代偿期患者血红蛋白浓度、铁蛋白浓度、转铁蛋白浓度及转铁蛋白饱和度分别为(14.2±2.4)g/dL、(161.1±23.1)mcg/L、(248.3±69.1)mg/dL及(34.6±3.1)mg/dL,均显著高于失代偿期患者[(11.3±2.8)g/dL、(138.4±27.2)mcg/L、(213.2±53.4)mg/dL及(29.7±3.7)mg/dL,P均<0.05]。失代偿期、代偿期乙型肝炎肝硬化患者贫血发生率差异具有统计学意义(P<0.05),同时失代偿期IDA发生率也显著高于代偿期乙型肝炎肝硬化患者(P<0.05)。未贫血患者血红蛋白浓度、铁蛋白浓度、转铁蛋白浓度及转铁蛋白饱和度为(13.7±2.8)g/dL、(165.1±27.1)mcg/L、(251.1±71.2)mg/dL及(36.8±4.2)mg/dL,均显著高于失代偿期患者[(10.4±2.3)g/dL、(135.2±26.5)mcg/L、(221.2±57.8)mg/dL及(29.7±3.1)mg/dL,P均<0.05]。在随访中,代偿期患者有44例进展为失代偿期,其中发生IDA16例。失代偿期有56例出现不良结局,其中21例出现大量腹水,10例出现肝肾综合征,5例发展为严重肝性脑病,13例出现静脉曲张出血,7例出现肝功能衰竭。失代偿期出现不良结局的患者中,发生IDA 45例。在代偿期和失代偿期患者中,出现IDA的患者更易发生不良临床结局(P<0.05)。结论乙型肝炎失代偿期肝硬化患者的IDA发生率较高。当出现IDA时,乙型肝炎代偿期和失代偿期肝硬化患者易出现不良临床结局。

关键词: 乙型肝炎, 肝硬化, IDA, 预后

Abstract: Objective To analyze the incidence of iron deficiency anemia and its influence on clinical outcomes in patients with compensatory and decompensated liver cirrhosis. Methods We conducted a retrospective analysis of cirrhosis patients with hepatitis B who were admitted to our hospital from February 2010 to May 2022. The patients were divided into compensatory stage and decompensated stage according to Child-Pugh classification of liver function. Serum transferrin and hemoglobin levels of all patients were collected, and the incidence of iron deficiency anemia was analyzed in both groups. The Chi-square test was used to compare the incidence of iron deficiency anemia between patients in the compensatory stage and those in the decompensated stage. The adverse outcomes of both groups were followed up to analyze the influence of iron deficiency anemia on the clinical outcomes of the two groups. Results A total of 189 cirrhosis patients with hepatitis B were included, comprising of 109 males and 80 females, with an age range of 32-68 years. Among them, 86 cases in the compensatory period, while 103 cases in the decompensated period. There were 14 cases (16.3%) and 88 cases (85.4%) of ascites in compensatory and decompensated patients, respectively, and the difference was statistically significant (P<0.05). In the compensatory period, there were 62 cases (72.1%) with no anemia, 16 cases (18.6%) with iron deficiency anemia, and 8 cases (9.3%) with anemia resulting from other causes. In the decompensated period, there were 37 cases (35.9%) with no anemia, 42 cases (40.8%) with iron deficiency anemia, and 24 cases (23.3%) with anemia resulting from other causes. The difference was statistically significant (P<0.05). The hemoglobin concentration, ferritin concentration, transferrin concentration and transferrin saturation in compensatory patients were (14.±2.4) g/dL, (161.1±23.1) mcg/L, (248.3±69.1) mg/dL and (34.6 3.1) mg/dL, respectively, which were significantly higher than those in decompensated patients [(11.3±2.8) g/dL, (138.4±27.2) mcg/L, (213.2±53.4) mg/dL and (29.7±3.7) mg/dL, P<0.05]. The difference in the incidence of anemia between decompensated and compensated patients with hepatitis B cirrhosis was statistically significant (P<0.05). Furthermore, the incidence of iron deficiency anemia in the decompensated period was significantly higher than that in compensated patients with hepatitis B cirrhosis (P<0.05). The hemoglobin concentration, ferritin concentration, transferrin concentration and transferrin saturation in patients without anemia were (13.7±2.8) g/dL, (165.1±27.1) mcg/L, (251.1±71.2) mg/dL and (36.8±4.2) mg/dL, respectively, which were significantly higher than those in patients with decompensation[(10.4±2.3) g/dL, (135.2±26.5) mcg/L, (221.2±57.8) mg/dL and (29.7±3.1) mg/dL, P<0.05]. During the follow-up, 44 patients in the compensatory period progressed to decompensated period, among which 16 patients developed iron deficiency anemia. There were 56 cases with adverse outcomes in the decompensation period, including 21 cases with massive ascites, 10 cases with hepatorenal syndrome, 5 cases with severe hepatic encephalopathy, 13 cases with varicose veins bleeding and 7 cases with liver failure. Among the patients with adverse outcome in the decompensation period, 45 cases had iron deficiency anemia. In the compensatory and decompensated patients, patients with iron deficiency anemia were more likely to have adverse clinical outcomes (P<0.05). Conclusion The incidence of iron deficiency anemia is higher in patients with hepatitis B decompensated cirrhosis. When iron deficiency anemia is present, patients with compensatory and decompensated hepatitis B cirrhosis are prone to adverse clinical outcomes.

Key words: Hepatitis B, Cirrhosis of the liver, Iron deficiency anemia, Prognosis

陈风娟, 龚建涛, 杨晓军, 王征球. 乙型肝炎代偿期和失代偿期肝硬化患者的缺铁性贫血发生率及其对临床结局的影响[J]. 肝脏, 2023, 28(10): 1175-1178.

CHEN Feng-juan, GONG Jian-tao, YANG Xiao-jun, WANG Zheng-qiu. Incidence of iron deficiency anemia in patients with compensatory and decompensated liver cirrhosis and its impact on clinical outcomes[J]. Chinese Hepatolgy, 2023, 28(10): 1175-1178.

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