内科综合治疗HBV-ACLF患者的临床特点及转归

目的了解HBV-ACLF内科治疗患者的临床特点及预后。方法回顾性分析140例接受内科综合治疗的HBV-ACLF患者临床资料,根据治疗效果分为有效组和无效组。比较两组患者临床特点。结果内科综合治疗有效98例,无效42例,死亡23例。有效组肝硬化病史、肝性脑病、消化道出血及肝肾综合征发生率均低于无效组(P<0.05)。Logistic多因素分析显示,肝性脑病(OR=1.869,95%CI=1.073~3.256)、消化道出血(OR=3.478,95%CI=1.621~7.462)、肝肾综合征(OR=4.141,95%CI=1.031~5.091)、INR(OR=3.081,95%CI=1.497~6.341)、Scr(OR=2.817,95%CI=1.629~4.871)和MELD评分(OR=1.305,95%CI=1.194~1.426)是影响其疗效的独立因素(P<0.05)。结论HBV-ACLF内科综合疗效肯定,恩替卡韦联合糖皮质激素有助于提高疗效,而对于合并并发症、肝功能下降及MELD评分升高者,内科治疗效果较差。

The clinical characteristics and prognosis of patients with HBV-ACLF treated by internal medicine

Objective To study the clinical characteristics and prognosis of patients with HBV-related acute-on-chronic liver failure(HBV-ACLF)treated by internal medicine.Methods The clinical data of 140 patients with HBV-ACLF who received comprehensive treatment of internal medicine in our hospital were retrospectively analyzed,the patients were divided into effective group and ineffective group,which accorded to the therapeutic effect.The clinical characteristics of the two groups were compared.Results The medical comprehensive treatment was effective in 98 cases,the effective rate was 70.00%,the ineffective was 42 cases and the ineffective rate was 30%.Among them,23 cases died and the mortality rate was 16.43%.The incidence of cirrhosis,hepatic encephalopathy,gastrointestinal bleeding and hepatorenal syndrome in the effective group were lower than that in the ineffective group(P<0.05).The Logistic multivariate analysis showed that the complications such as hepatic encephalopathy(OR=1.869,95%CI=1.073~3.256),gastrointestinal bleeding(OR=3.478,95%CI=1.621~7.462),hepatorenal syndrome(OR=4.141,95%CI=1.031~5.091)and INR(OR=3.081,95%CI=1.497~6.341),Scr(OR=2.817,95%CI=1.629~4.871)and MELD scores(OR=1.305,95%CI=1.194~1.426)were independent factors which affected the efficacy(P<0.05).Conclusion The comprehensive curative effect of HBV-ACLF is affirmative.The entecavir combined with glucocorticoid is helpful to improve the curative effect.The patients who decreased liver function and elevated MELD score,the therapeutic effect of internal medicine for those with complications is worse.