失代偿期肝硬化患者肝损伤急性加重100例临床分析

目的 探讨失代偿期肝硬化肝损伤急性加重患者在肝衰竭分型中的合理定位，为临床诊治提供参考依据。方法 采用回顾性分析法，纳入我院失代偿期肝硬化肝损伤急性加重患者100例和慢加急性肝衰竭（ACLF）患者200例，使用罗氏COBAS INTEGRA 800检测血生化指标；采用摆动磁珠凝固法检测凝血指标。应用SPSS16.0软件对两组患者临床资料进行分析。结果 在300例患者中，由肝炎病毒活动性复制引起的急性肝损伤220例（73.3%），其他诱因引起者80例（26.7%）；肝硬化组血清白蛋白和血钠分别为（27.2±4.2）g/l和130.5（90.1， 143.8）mmol/l，显著低于肝衰竭组的（29.5±4.5）g/l和134.2（78.7， 143.0）mmol/l（P＜0.05）；肝硬化组肝肾综合征、自发性腹膜炎、低钠血症发生率分别为26.0%、57.0%、75.0%，均显著高于肝衰竭组的13.0%、42.0%、53.0%（P＜0.05）；肝硬化组好转率为10.0%，显著低于肝衰竭组的25.5%（P＜0.05）。结论 在失代偿期肝硬化基础上因某种诱因导致肝损伤急性加重患者具有与ACLF患者相似的急性肝功能失代偿表现，同时也存在门脉高压为主的表现，其在肝衰竭分型中的合理定位尚需扩大病例数，进一步深入临床研究。

Clinical features of 100 patients with acute exacerbation of cirrhosis with liver function decompensation

Objective To investigate the reasonable diagnosis of patients with acute exacerbated liver function in patients with decompensated liver cirrhosis. Methods 100 patients with acute exacerbated liver function with underlying decompensated cirrhosis and 200 patients with acute on chronic liver failure （ACLF） were retrospectively analyzed in our hospital. Blood biochemical parameters and blood coagulation function index were routinely detected. SPSS 16.0 software was used to analyze the clinical materials. Results Active replication of hepatitis B virus-induced acute liver injuries accounted for（73.3%），and other causes for（26.7%） in the 300 patients；serum levels of albumin and serum sodium in patients with liver cirrhosis were（27.2±4.2） g/l and 130.5（90.1，143.8） mmol/l，significantly lower than in patients with ACLF（29.5±4.5） g/l and 134.2（78.7，143.0），P＜0.05）；In liver cirrhosis group，the occurrence rates of hepatorenal syndrome，spontaneous bacterial peritonitis and hyponatremia were 26.0%，57.0% and 75.0%，much higher than in patients with ACLF （13.0%，42.0% and 53.0%， respectively （P＜0.05），while there was no statistical significances in hepatic encephalopathy，gastrointestinal bleeding and infection （P＞0.05） between the two groups；the recovery rate was 10.0% in cirrhosis patients，much lower than 25.5% in ACLF patients（P＜0.05）. Conclusion The exacerbated liver function in patients with decompensated liver cirrhosis tends to has some precipitating factors. The patients presents with the same clinical manifestations of acute liver decompensation in patients with ACLF and portal hypertension. What type of hepatic failure should it be needs further investigation.