105例乙肝相关性慢加急性肝衰竭的临床分析

Clinical analysis of 105 patients with acute-on-chronic hepatitis B liver failure

目的探讨乙肝相关性慢加急性肝衰竭诱因及转归的影响因素。方法采用肝衰竭国内外共识会议的诊断标准,收集近3年115例慢加急性肝衰竭患者的住院临床资料,着重分析105例乙肝相关性慢加急性肝衰竭诱因及转归的影响因素。结果115例中乙肝病毒感染105例,占绝大多数。诱因分别为乙肝活动63例(60.0%),其他感染因素11例(10.5%),药物损害8例(7.6%),酒精损害2例(1.9%),28例(26.7%)未发现明确诱因,其中共7例存在多重诱因。药物诱发的乙肝慢加急性肝衰竭死亡/恶化比例最高(60.0%～66.67%)。总胆红素、直接胆红素、凝血酶原活动度、白细胞及中性粒细胞比值等反映病情程度生化指标,在死亡、恶化、未愈、好转4组间的差异具有统计学意义(P<0.05)。死亡组/恶化组肝性脑病发生率显著高于未愈组/好转组(P<0.05),而存在2种或2种以上并发症影响转归,好转组发生率最低,且与其他3组的差异具有统计学意义。结论乙肝相关性慢加急性肝衰竭的临床过程复杂,其转归与诱因、并发症以及反映病情程度的生化指标改变明显相关。

Objective To investigate the acute insults and risk factors of prognosis for hepatitis B related acute-on-chronic liver failure.Methods The 105 cases of HBV related acute-on-chronic liver failure in last three years were retrospectively studied.International consensus criteria were applied to assess the causality of prognosis,in which the acute insults and risk factors were analyzed.Results Among 115 adult in-patients with HBV related acute-on-chronic liver failure,over 3-year period,105 patients were recorded as HBV infection,accounted for the vast majority.The most common acute insult was HBV activation,found in 63 patients（60.0%）.others insults,such as sepsis was found in 11cases（10.5%）,medication was found in 8 cases（7.6%）,still 28 cases（26.7%） were lack of clear cause. The proportion of deaths/deterioration was highest in medication related acute-on-chronic HBV liver failure（60.0%～66.67%） .There were statistic difference among deaths/deterioration/healed/improved groups in the chemical risk factors that reflecting conditions,such as TBil,DBil,PTA,WBC,Neutrophil（P〈0.05）. The incidence of hepatic encephalopathy in deaths/deterioration groups was higher than healed/improved groups（P〈0.05）.Existing two or more kinds of complications affected prognosis,which was lowest in improved group,being statistic difference when Pair wise comparison among the four groups.Conclusion Because of complicated clinical course in HBV related acute-on-chronic liver failure,the prognosis was related with the acute insults and complications and the chemical risk factors that reflecting conditions.