乙型肝炎相关失代偿期肝硬化首次再代偿后发生再次失代偿的风险因素分析

摘要/Abstract

摘要： 目的分析并探讨乙型肝炎(HBV)相关失代偿期肝硬化经治疗后首次再代偿后发生再次失代偿的风险因素。方法采用回顾性研究方法,通过电话回访及查阅病历系统,纳入2017年1月至2021年1月期间在本院肝病科门诊及住院诊治的412例HBV相关初次失代偿期肝硬化患者,将符合再代偿的203例患者作为研究对象。连续随访观察12个月,根据是否出现失代偿表现,分为持续代偿期组(102例)和再失代偿期组(101例),将2组性别及年龄等一般资料、初次失代偿时生化学指标、首次失代偿事件、器官损伤情况、Child-Pugh评分、血清HBV DNA转阴情况等指标进行组间比较,再采用单因素二元logistic回归分析与多因素二元logistic回归分析,分析探讨再代偿后发生再次失代偿的风险因素。结果初次失代偿事件时多个并发症、初次失代偿时生化学指标(CHE、Cr)、6个月时HBV DNA转阴率及6个月时Child-Pugh评分为HBV相关失代偿期肝硬化首次再代偿后发生再次失代偿的风险因素(P<0.05),其中初次失代偿时高血清CHE水平、6个月时HBV DNA阴转为再代偿状态后发生再次失代偿的保护因素,而初次失代偿时多个并发症、高血清Cr、6个月时高Child-Pugh评分则是再代偿状态后发生再次失代偿的危险因素。结论经过抗病毒等综合治疗后,大约49.27%患者可实现再代偿,初次失代偿事件时并发症个数、初次失代偿时生化学指标(CHE、Cr)及随访监测过程中HBV DNA、Child-Pugh评分可为再代偿状态维持的预判提供参考。

关键词: HBV相关失代偿期肝硬化, 再代偿, 维持, 影响因素

Abstract: Objective To analyze and identify the risk factors associated with recurrent decompensation in patients with HBV-related decompensated cirrhosis after treatment-induced re-compensation. Methods A retrospective study was conducted by telephone follow-up and review of medical records to select HBV-related patients with initial decompensated cirrhosis treated in the department of hepatology from January 2017 to January 2021. Patients whose liver function recovered to a recompensated state after comprehensive treatment, including antiviral therapy, were included as study subjects. Continuous follow-up was conducted for 12 months. Based on the occurrence of decompensation, patients were divided into a sustained compensation group and a re-decompensation group. The groups were compared for general information such as gender and age, biochemical indicators at the time of initial decompensation, the first decompensation event, organ damage, Child-Pugh score, and serum HBV-DNA negativity. Multivariate binary logistic regression analysis was performed, including indicators with statistical significance (P<0.2) from univariate binary logistic regression analysis, to explore risk factors for re-decompensation after re-compensation. Results This study initially included 412 patients, with 203 cases (49.27%) achieving re-compensation after treatment and follow-up. These 203 patients were continuously observed over 12 months and were categorized into two groups based on the presence of decompensation: sustained re-compensation (102 cases) and recurrent decompensation (101 cases). Comparative analysis between the groups revealed statistically significant differences in disease course, number of complications during initial decompensation, biochemical indicators including total bilirubin (TBil), cholinesterase (CHE), prealbumin (PA), creatinine (Cr), FBG (fast blood glucose), procalcitonin (PCT) during the initial decompensation, Child-Pugh scores (at initial decompensation, 6 months, and 12 months), and the HBV-DNA negative conversion rate at 6 months (P<0.05). Univariate binary logistic regression analysis identified variables with P<0.2, including disease course, multiple complications during initial decompensation, biochemical indicators (TBil, CHE, Cr) during initial decompensation, Child-Pugh scores (at initial decompensation, 6 months, and 12 months), and the HBV-DNA negative conversion rate (at 6 and 12 months), which were then included in a multivariate binary logistic regression analysis (stepwise regression). The results indicated that multiple complications during the initial decompensation event, biochemical indicators (CHE, Cr) during initial decompensation, the HBV-DNA negative conversion rate at 6 months, and the Child-Pugh score at 6 months were risk factors for recurrent decompensation after the first re-compensation in HBV-related decompensated cirrhosis (P<0.05). Specifically, high serum CHE levels during initial decompensation and the negative conversion of HBV-DNA at 6 months were protective factors against recurrent decompensation after re-compensation, while multiple complications during initial decompensation, high serum Cr levels, and a high Child-Pugh score at 6 months were risk factors for recurrent decompensation after re-compensation. Conclusion After comprehensive treatments including antiviral therapy, approximately 49.27% of patients can achieve re-compensation. The number of complications during the first decompensation event, biochemical indicators (CHE, Cr) at the initial decompensation, and HBV-DNA and Child-Pugh scores during follow-up monitoring can provide predictive references for the maintenance of re-compensation.

Key words: HBV-related decompensated cirrhosis, Recompensation, Maintenance, Influencing factors

许佳珺, 缪幼菡, 俞冲, 王忠成, 顾尔莉, 李民. 乙型肝炎相关失代偿期肝硬化首次再代偿后发生再次失代偿的风险因素分析[J]. 肝脏, 2025, 30(7): 906-911.

XU Jia-jun, MIAO You-han, YU Chong, WANG Zhong-cheng, GU Er-li, LI Min. The risk factors affecting the maintenance of the first re-compensatory state in patients with HBV-related decompensated cirrhosis[J]. Chinese Hepatolgy, 2025, 30(7): 906-911.

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