摘要
目的探讨慢加急性肝衰竭(ACLF)患者预后的影响因素,以及人工肝治疗对该病预后的影响。方法回顾性分析2016年1月至2019年12月合计201例ACLF患者的临床资料,使用Kaplan-Meier法计算生存率,单因素分析Log-rank检验,Cox逐步向前回归法进行多因素回归分析。结果患者中位生存时间6个月,6、9、12个月的生存率分别为51.2%、38.3%、29.9%。单因素分析结果中,年龄、有无高血压、有无上消化道出血、治疗方式、终末期肝病模型(MELD)评分、胆碱酯酶与预后有关(P值均<0.05)。多因素回归分析结果显示,MELD评分是影响ACLF患者1年预后的主要因素(P=0.002);人工肝治疗对年龄<50岁或MELD评分≥20分的ACLF患者1年预后有益(P<0.05);高龄(≥50岁)患者的相对死亡风险比(RR)是低龄的2.55倍(P<0.001);以年龄作为分层因素进行回归分析,上消化道出血与低龄的预后有关,胆碱酯酶与高龄的预后有关;以MELD评分分层后进行回归分析,年龄、高血压与MELD<20分的患者预后有关,治疗方式、年龄与MELD≥20分的患者预后有关。结论人工肝治疗对ACLF患者1年的预后有益,年龄、MELD评分、高血压病、上消化道出血是影响ACLF患者预后的独立危险因素。
Objective To explore the influencing factors and the impact of artificial liver treatment on the prognosis and survival of patients with acute-on-chronic liver failure(ACLF).Methods Clinical data from 201 cases with ACLF from January 2016 to December 2019 was retrospectively analyzed.The survival rate was calculated by the Kaplan-Meier method,the log-rank test of univariate analysis,and the multivariate analysis of the stepwise Cox regression forward method.Results The median survival time of patients was 6 months,and the survival rates at 6,9,and 12 months were 51.2%,38.3%,and 29.9%,respectively.In univariate analysis,age,presence or absence of hypertension and upper gastrointestinal bleeding,treatment method,model for end-stage liver disease(MELD)score,and cholinesterase were associated with prognosis(P<0.05).Multivariate regression analysis results showed that MELD score was the main factor affecting the 1-year prognosis of ACLF patients(P=0.002).Artificial liver treatment was beneficial for the 1-year prognosis of ACLF patients aged<50 years or with a MELD score of≥20(P<0.05).The relative risk ratio(RR)of mortality was 2.55 times higher in patients with advanced age(≥50 years old)than that of younger patients(P<0.001).Regression analysis was performed using age as a stratification factor,and upper gastrointestinal bleeding was related to the prognosis of younger patients,while choline esterase was related to the prognosis of advanced age.Regression analysis after stratified MELD score showed that age and hypertension were related to the prognosis of patients with MELD score<20,and treatment method and age were related to the prognosis of patients with MELD score≥20.Conclusion Artificial liver treatment is beneficial for the 1-year prognosis of ACLF patients.Age,MELD score,hypertension,and upper gastrointestinal bleeding are independent risk factors affecting the prognosis ofACLF patients.
作者
马万龙
马玉
王伟红
丁向春
焦运
刘帅伟
海龙
Ma Wanlong;Ma Yu;Wang Weihong;Ding Xiangchun;Jiao Yun;Liu Shuaiwei;Hai Long(Department of Infectious Diseases,Ningxia Medical University General Hospital,Yinchuan 750004,China;Department of Nutrition,Ningxia Medical University General Hospital,Yinchuan 750004,China)
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2023年第10期1051-1055,共5页
Chinese Journal of Hepatology
基金
北京肝胆相照公益基金会2021年度人工肝专项基金(RGGJJ-2021-024)。
关键词
慢加急性肝衰竭
人工肝
预后
Acute-on-chronic liverfailure
Artificial liver
Prognosis
