HBV相关慢加急性肝衰竭发病诱因分析

目的分析HBV相关慢加急性肝衰竭（HBV-related acute-on-chronic liver failure, HBV-ACLF）诱因及预后影响因素。方法回顾性分析我院2007年3月-2010年2月收治的HBV—ACLF病例资料，对其诱因、临床转归及预后相关因素进行统计学分析。结果509例HBV—ACLF中，HBeAg（＋）287例，HBeAg（-）222例。能够追寻到明确诱因的，以抗病毒治疗相关因素为主，共67例，占13．2％。HBeAg（＋）与HBeAg（-）ACLF相比，抗病毒治疗相关因素诱发HBV—ACLF差异有统计学意义，分别为48例（16．7％）和19例（8．6％）。HBeAg（＋）和HBeAg（-）患者中断抗病毒治疗至发生ACLF的时间差异无统计学意义。509例HBV—ACLF治愈或好转266例（52．3％）。各诱发因素所致ACLF治愈好转率差异无统计学意义。Logistic回归多因素分析发现，HBV—ACLF预后与基础疾病、HBVDNA水平、病情分期及发病后是否采用抗病毒治疗密切相关。不能明确诱因的HBV-ACLF共210例（41．3％）。结论抗病毒药物的广泛应用使HBV-ACLF的诱因分布发生了变化，应重视抗病毒药物应用的规范化。一旦发生ACLF预后差，应及时给予适当的抗病毒治疗，并重视基础疾病的综合治疗。

Causes of HBV-related acute-on-chronic liver failure

Objective To analyze the causes and prognostic factors of HBV-related acute-on-chronic liver failure （HBV- ACLF）. Methods A retrospective study was carried out on the patients with HBV-ACLF treated in our hospital from Mar. 2007 to Feb. 2010. The causes, clinical outcome and prognostic factors of the patients were statistically analyzed. Results Of 509 HBV- ACLF patients, 287 were HBeAg positive and 222 HBeAg negative. Factors related to antiviral therapy caused HBV-ACLF in 67 patients （13.2%）. There were significant differences in the factors related to antiviral therapy between HBeAg positive patients and HBeAg negative patients [48 cases （16.7%） vs. 19 cases （8.6%）]. The time from discontinuation of antiviral therapy to the occur- rence of ACLF was not significantly different between HBeAg positive patients and HBeAg negative patients. Of 509 HBV-ACLF patients, 266 （52.3%） were cured or improved, and in these patients the causes of HBV-ACLF made no significant differences. Logistic regression analysis showed that the prognosis of HBV-ACLF was correlated with underlying diseases, serum HBV DNA level, dis- ease stage and whether receiving antiviral therapy or not. The causes of HBV-ACLF couldn＇t be confirmed in 210 patients （41.3%）. Conclusions The extensive use of antiviral agents results in the change of the causes of HBV-ACLF, so great importance should be attached to the standardized use of antiviral agents. Once ACLF occurs, the prognosis is poor, therefore antiviral therapy should be given promptly and comprehensive therapy should be emphasized as wen in HBV-ACLF patients.