HBV相关慢加急性肝衰竭不同分期的预后评价及影响因素分析

目的评价不同分期慢性HBV感染相关慢加急性肝衰竭的预后,并分析影响预后的因素。方法回顾性分析180例慢加急性肝衰竭（ACLF）患者的住院生存时间,通过Logistic回归与Cox回归分析不同预后的影响因素。结果 Kaplan-Meier显示不同分期ACLF患者累积生存率存在统计学差异（P〈0.001）,早期、中期、晚期ACLF患者住院期间生存期逐渐缩短（P〈0.001）;Lo-gistic多因素回归显示,有无结肠灌肠、是否并发肝性脑病和/或肝肾综合征、PTA、TBil及Alb水平是影响ACLF患者生存与否的独立因素（P〈0.05或P〈0.01）;Cox回归多因素分析显示,有无结肠灌肠、是否并发肝性脑病、疾病分期、WBC及CHE水平为ACLF住院生存期的独立影响因素（P〈0.05或P〈0.01）。结论早期ACLF患者较中晚期ACLF患者预后好,基线WBC、TBil、CHE及Alb水平为ACLF患者预后的影响因素,结肠灌肠可能对提高生存率延长生存期有积极治疗意义。

Risk factors associated with prognosis of progressive stages of acute-on-chronic hepatitis B liver failure

Objective To identify the risk factors associated with progression of acute - on - chronic liver failure （ACLF） occurring in pa- tients with chronic hepatitis B virus （HBV） infection （ CHB ）. Methods The clinical, demographic, treatment and outcome data of 180 ACLF patients with concomitant CHB managed in our hospital between June 2009 and September 2012 were retrospectively reviewed. Clinical data, taken at baseline, included markers of inflammation/itffection （white blood cell （WBC） count）, coagulation （prothrombin time （PT） and prothrombin activity （PTA））, and liver function （alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, total bilirubin （ TBil）, direct bilirubin （DBil） , choninesterase （ CHE）, albumin （Alb） , globulin （Glb） , total cholesterol （ TC ） , and ammonia）. In - hos- pital treatments included supplementation with traditional Chinese medicine - based therapies, such as Tuihuang decoction and detoxification enema. The primary outcome was survival during hospitalization. The patients were grouped for analysis according to ACLF stage （ early, n = 93 ; mid, n = 61 ; late, n = 26 ） and the risk factors associated with each stage were identified by using univariate （ log - rank test） and multiva- riate （Cox＇s test） regression analyses. The association of risk factors with patient survival was assessed by Kaplan - Meier curve analysis. Results The three ACLF groups showed significantly different amounts of leukocytes, with the late ACLF group showing the highest WBC. The late ACLF group also showed significantly lower Glb and TC. There was a trend in reduced cumulative survival rate and shorter time to death that significantly corresponded to progressive stages of ACLF （ early ACLF 〉 mid ACLF 〉 late ACLF ; all P 〈 0.001 ）. One - hundred - and -twenty -six （70.0%） of the patients died during their hospitalization, and multivariate regression analysis of this entire patient popula- tion identified absence of colonic enema, presence of hepatic encephalopathy, presence of hepatorenal syndrome, PTA level, TBil level, and Alb level as potential risk factors of death. The Kaplan - Meier survival analysis showed that colonic enema, hepatic encephalopathy, disease stage, WBC level, TBil level, and CHE level were associated with patient survival during the hospitalization period. Conclusion CHB pa- tients with early ACLF have better prognosis than those with mid or late ACLF. Baseline levels of WBC, TBil, CHE, and Alb may influence a patient ＇ s survival, regardless of ACLF stage. Supplemental treatment by colonic enema led to improved rates of survival in the ACLF patients.