摘要
目的分析非乙型肝炎(乙肝)肝衰竭及乙肝肝衰竭的病因及临床指标特征,评价其在反映疾病结局中的潜在作用。方法回顾分析2018年1月至2020年12月无锡市肝衰竭定点救治医院无锡市第五人民医院重症监护病房(ICU)收治的369例肝衰竭患者的临床资料。按照《肝衰竭诊治指南(2018年版)》对非乙肝肝衰竭和乙肝肝衰竭患者的临床特征进行分类比较,分析肝衰竭相关病因指标,包括性别、年龄、抗凝血酶Ⅲ(ATⅢ)、总胆红素(TBil)、ICU住院时间、肝性脑病、合并症(肝硬化、肝癌等)及人工肝治疗情况;根据患者出院后6个月随访结果,分析死亡与存活患者病因指标的差异及不同类型肝衰竭患者的临床转归。结果369例患者均纳入分析,其中非乙肝引起的肝衰竭134例(36.3%),乙肝引起的肝衰竭235例(63.7%)。乙肝组男性患者是女性的4.34倍(例:191比44),略高于非乙肝组的1.03倍(例:68比66)。6个月随访结果显示,乙肝组死亡及存活患者的男性比例均显著高于女性(死亡患者:78.76%比21.24%,存活患者:92.86%比7.14%,均P<0.01);非乙肝组死亡患者的年龄显著大于存活患者(岁:58.53±0.15比54.38±3.01,P<0.05),同时ATⅢ活性显著低于存活患者〔(32.20±6.43)%比(38.63±2.74)%,P<0.05〕;乙肝组死亡患者ICU住院时间显著短于存活患者(d:23.77±11.74比35.51±2.85,P<0.01);乙肝组合并肝癌患者出院6个月病死率显著高于非乙肝组(12.34%比2.24%,P<0.01),但不同类型肝衰竭组间人工肝治疗及合并肝性脑病、肝硬化患者出院6个月病死率差异均无统计学意义。结论乙肝是引发肝衰竭的主要病因;乙肝肝衰竭患者年龄小、住院时间长,有利于病情恢复;乙肝肝衰竭合并肝癌是死亡的主要因素;ATⅢ可能是反映疾病结局的潜在指标。
Objective To analyze the characteristics of etiology and clinical indicators of hepatitis B virus(HBV)and non-HBV liver failure,and to evaluate their potential roles in reflecting disease outcomes.Methods The clinical data of 369 patients with liver failure admitted to the intensive care unit(ICU)of the Fifth People's Hospital of Wuxi which was the designated hospital for treatment of liver failure from January 2018 to December 2020 were retrospectively analyzed.The classification and comparison of etiology of non-HBV and HBV liver failure patients were performed according to the Guidelines on the Diagnosis and Treatment of Liver Failure(2018 edition).The indicators of liver failure related etiologies,including gender,age,anticoagulant enzymeⅢ(ATⅢ),total bilirubin(TBil),length of ICU stay,hepatic encephalopathy,underlying disease(liver cirrhosis and liver cancer,etc.)and usage of artificial liver were analyzed.According to the 6-month follow-up results after discharge,the differences in the etiological indicators of died and survival patients and the outcome of patients with different types of liver failure were analyzed.Results A total of 369 patients were enrolled,including 134(36.3%)with liver failure not caused by HBV and 235(63.7%)with liver failure caused by HBV.The male with HBV-related liver failure was 4.34 times higher than female(cases:191 vs.44),which was higher than non-HBV-related liver failure(1.03 times,cases:68 vs.66).The 6-month follow-up showed that the proportion of male with HBV-related liver failure who died and survived was significantly higher than that of female(78.76%vs.21.24%in died patients,92.86%vs.7.14%in survival patients,both P<0.01).The age of died patients in the non-HBV-related liver failure group was significantly higher than that of the survival patients(years:58.53±0.15 vs.54.38±3.01,P<0.05),and the ATⅢlevel was significantly lower than that of the survival patients[(32.20±6.43)%vs.(38.63±2.74)%,P<0.05].The length of ICU stay of the died HBV-related liver failure gr
作者
阎岩
吕春燕
戈丽娜
周美芳
Davgadorj Chantsalmaa
Yan Yan;Lyu Chunyan;Ge Li'na;Zhou Meifang;Davgadorj Chantsalmaa(Laboratory for Infection and Immunity,the Fifth People's Hospital of Wuxi,Wuxi 214016,Jiangsu,China;Clinical Laboratory Center,the Fifth People's Hospital of Wuxi,Wuxi 214016,Jiangsu,China;Department of Infectious Diseases,the Fifth People's Hospital of Wuxi,Wuxi 214016,Jiangsu,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2022年第11期1173-1177,共5页
Chinese Critical Care Medicine
基金
国家自然科学基金(81701550)
江苏省无锡市卫生健康委中青年医疗卫生拔尖人才培养计划项目(BJ2020094)。
关键词
肝衰竭
乙型肝炎
抗凝血酶Ⅲ
肝癌
Liver failure
Hepatitis B
Anticoagulant enzymeⅢ
Liver cancer
