摘要
目的观察人工肝支持系统(ALSS)治疗的乙型肝炎病毒(HBV)相关慢加急性肝功能衰竭(ACLF)患者的转归,研究影响其预后的相关因素。方法 2011年1月-2014年6月收治HBV-ACLF患者321例,收集患者入院后基线及ALSS治疗前后的临床资料,进行单因素分析及多因素回归分析,筛选出影响患者30 d预后的独立危险因素。结果 321例患者在30 d观察终点时,存活233例,死亡88例。单因素分析结果显示:死亡组合并肝硬化基础及肝肾综合征、肝性脑病、腹膜炎的发生率较存活组高,差异有统计学意义(P<0.05);死亡组的终末期肝病评分模型分值、白细胞计数、血氨、肌酐、各阶段的总胆红素水平高于存活组,差异有统计学意义(P<0.05);死亡组的基础HBV-DNA载量、3次ALSS治疗后总胆红素下降水平、基线凝血酶原活动度及3次ALSS治疗后凝血酶原活动度低于存活组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示白细胞计数(OR=2.337,P<0.001)、3次ALSS治疗后的总胆红素水平(OR=4.935,P<0.001)是预测经ALSS治疗的HBV-ACLF患者30 d死亡的独立危险因素,HBV-DNA(OR=0.403,P<0.001)、3次ALSS治疗后总胆红素下降水平(OR=0.447,P<0.001)及3次ALSS治疗后凝血酶原活动度水平(OR=0.332,P<0.001)是30 d预后的保护因素。结论白细胞计数、HBV-DNA载量、3次ALSS治疗后总胆红素及凝血酶原活动度水平、3次ALSS治疗后总胆红素下降水平是影响ALSS治疗HBV-ACLF患者短期预后的5个主要因素,在临床实践中,将其作为判断预后的指标对临床决策的制定有一定的指导价值。
Objective To learn the outcomes of hepatitis B virus （HBV）-related acute-on-chronic liver failure （ACLF） cases after artificial liver support system （ALSS） treatment and the relevant factors correlated with the clinical outcomes. Methods In the period from January 2011 to June 2014, 321 patients with HBV-ACLF were admitted to West China Hospital. The clinical data at baseline, before and after treatment were analyzed by univariate and multivariate logistic regressions to identify the independent risk factors correlated with 30-day outcomes. Results Of all the 321 patients, 233 survived and 88 died by the end of a 30-day observation. The univariate analysis identified that the incidences of cirrhosis, hepatorenal syndrome and peritonitis in the death group were significantly higher （P 〈 0.05）. ~he model for end-stage liver disease values, white blood cells （WBC）, blood ammonia, creatinine and total bilirubin （TBIL） at different stages in the death group were significantly higher than those in the survival group （P ~ 0.05）. In the death group, the HBV-DNA, TBIL decrease after triple ALSS treatments, baseline prothrombin time activity （PTA） and PTA level after triple ALSS treatments were significantly lower （P 〈 0.05）. The multivariate logistic regression indicated that WBC （OR=2.337, P 〈 0.001） and TBIL level after triple ALSS treatments （OR=4.935, P 〈 0.001） were independent predicting factors for death within 30 days after ALSS treatment; HBV-DNA （OR=0.403, P 〈 0.001）, the decrease of TBIL after triple ALSS treatments （0R=0.447, P 〈 0.001） and PTA level after triple ALSS treatments （OR=0.332, P 〈 0.001） were protecting factors for the 30-day prognosis. Conclusions These five factors including WBC, HBV-DNA, PTA, TBIL and TBIL decrease after triple ALSS treatments influence the short-term prognosis for HBV-ACLF patients, which are valuable for decision making in clinical practices.
出处
《华西医学》
CAS
2016年第9期1516-1520,共5页
West China Medical Journal
基金
四川省科技厅科技支撑计划项目(2015SZ0049)~~
