首次失代偿期乙型肝炎肝硬化伴食管胃底静脉曲张破裂出血再代偿的临床特征及影响因素研究

摘要/Abstract

摘要： 目的探讨实现再代偿的失代偿期乙型肝炎肝硬化伴食管胃底静脉曲张破裂出血患者的临床特征及影响因素。方法回顾性分析2015 年1月至2024年1月包头医学院第二附属医院因乙型肝炎肝硬化住院的患者,以所有患者发生首次再代偿或者≥2次失代偿(持续失代偿)为随访终点,根据患者结局将所有患者分为再代偿组和持续失代偿组,分析再代偿的独立影响因素。比较不同代偿状态患者累计发生肝癌的差异。结果 69例失代偿期乙型肝炎肝硬化患者经过抗病毒治疗后,最终32例发生再代偿,37例为持续失代偿。年龄(HR=0.94,95%CI:0.90~0.99,P=0.02) 、CTP评分(HR=0.63,95%CI :0.46~0.86 P<0.05) 、MELD评分(HR=0.90,95%CI:0.85~0.96,P<0.05) 是再代偿的保护因素。再代偿组与首次失代偿时临床资料对比,CTP评分[再代偿时6.12±1.07分 vs.首次失代偿时7.91±1.59分,OR=1.79,95%CI:1.01~3.16, P=0.05]、Alb[再代偿时(38.80±4.51)g/L vs.首次失代偿时(30.98±4.98)g/L,OR=0.82,95%CI:0.68~0.97,P=0.02] 、Hb[再代偿时(123.28±28.96)g/L vs.首次失代偿时(89.69±23.49)g/L,OR=0.96,95%CI:0.93~0.99,P=0.01]差异有明显统计学意义。再代偿患者肿瘤的发生率明显低于失代偿患者(HR=0.23,95%CI:0.37~0.57,P=0.02)。结论较小年龄,较低的CTP评分、MELD评分患者更容易实现再代偿,再代偿患者的肿瘤累计发生率低于持续失代偿患者。

关键词: 乙型肝炎肝硬化, 食管胃底静脉曲张, 再代偿, 肝癌

Abstract: Objective To explore the clinical characteristics and influencing factors of patients with first-time decompensated hepatitis B-related cirrhosis accompanied by esophageal and gastric fundus variceal rupture and bleeding who have achieved recompensation. Methods A retrospective study was conducted on 69 inpatients with hepatitis B-related cirrhosis in the Second Affiliated Hospital of Baotou Medical College from January 2015 to January 2024. All patients were followed-up with the occurrence of the first recompensation or ≥2 decompensations (continuous decompensation) as the end-point. Based on their outcomes the patients were divided into a recompensation group and a continuous decompensation group. The independent influencing factors of re-compensation were analyzed. The differences in the cumulative occurrences of liver cancer were analyzed among patients with different compensatory states. Results Among the 69 patients with decompensated hepatitis B-related cirrhosis, 32 cases ultimately achieved re-compensation and 37 cases remained decompensation after antiviral treatment. Compared the data of patients in re-compensation group with those of persistent decompensation group, age (HR=0.94, 95%CI: 0.90~0.99, P=0.02), CTP scores (HR=0.63, 95%CI: 0.46~0.86, P<0.05), MELD scores (HR=0.90, 95%CI: 0.85~0.96, P<0.05) were identified to be independent influencing factors of re-compensation; When compared the clinical data of patients at re-compensation with those at first decompensation, there were significant statistical differences in CTP scores [(6.12±1.07) score vs. (7.91±1.59) score, OR=1.79, 95%CI: 1.01~3.16, P=0.05], Alb [(38.80±4.51)g/L vs. (30.98±4.98)g/L, OR=0.82, 95%CI: 0.68~0.97, P=0.02], Hb [(123.28±28.96)g/L vs. (89.69±23.49)g/L, OR=0.96, 95%CI: 0.93~0.99, P=0.01]; The incidence of tumors in patients with re-compensation was significantly lower than that in patients with continuous decompensation (HR=0.23, 95%CI: 0.37~0.57, P=0.02). Conclusion Compared with the baseline data of the patients with first decompensation, there were significant improvements in CTP score, Alb and Hb in the patients of re-decompensation group. Compared with the data of the continuous decompensation group, patients with younger age, lower CTP scores and MELD scores were more likely to achieve re-compensation, and the cumulative incidence of tumors in re-compensated patients was significantly lower than that in the continuous decompensation patients.

Key words: Hepatitis B cirrhosis, Esophageal and gastric fundus variceal, Recompensation, Liver cancer

李文婷, 王晶, 党彤, 江振宇. 首次失代偿期乙型肝炎肝硬化伴食管胃底静脉曲张破裂出血再代偿的临床特征及影响因素研究[J]. 肝脏, 2026, 31(2): 177-181.

LI Wen-ting, WANG Jing, DANG Tong, JIANG Zhen-yu. The clinical characteristics and influencing factors of recompensation in patients with first-time decompensated hepatitis B-related cirrhosis with esophageal and gastric fundus variceal rupture and bleeding[J]. Chinese Hepatolgy, 2026, 31(2): 177-181.

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