中晚期慢性乙型重型肝炎预后影响因素分析

Factors influencing the prognosis of middle and advanced stages of chronic severe hepatitis B

目的探讨中晚期慢性乙型重型肝炎的预后影响因素,为制定中西医结合治疗方案提供依据。方法对2005年7月—2009年7月我院收治的578例中晚期慢性乙型重型肝炎患者给予常规中西医结合保肝、退黄、抗病毒、支持和对症等治疗,部分患者接受人工肝治疗。分析影响中晚期慢性乙型重型肝炎预后的因素。结果 578例慢性乙型重型肝炎患者治疗有效率为37.7%,无效率为62.3%;影响预后的高危因素包括肝肾综合征、肝性脑病和消化道出血。结论慢性乙型重型肝炎中晚期患者预后差,影响预后的因素包括肝肾综合征、肝性脑病和消化道出血等严重并发症,而并发症之间又相互影响,有效控制并发症是提高中晚期慢性乙型重型肝炎疗效的途径之一。

Objective To investigate the prognostic factors influencing middle and advanced stages of chronic severe hepatitis B and provide evidence for the formulation of therapeutic regimen of combined traditional Chinese medicine （TCM） and western medicine. Methods Totally 578 patients with middle and advanced stages of chronic severe hepatitis B received general treatment of combined TCM and western medicine, including liver-protecting, jaundice-reducing, antiviral, supporting and symptomatic treatment, in our hospital from Jul. 2005 to Jul. 2009. Some patients were treated with artificial liver support system additionally. The prognostic factors influencing the middle and advanced stages of chronic severe hepatitis B were analyzed. Results The total effective rate was 37.7% in 578 patients with middle and advanced stages of chronic severe hepatitis B, and ineffective rate was 62.3%. The factors influencing the prognosis were hepatorenal syndrome, hepatic encephalopathy and alimentary tract hemorrhage. Conclusions Poor prognosis is seen in the patients with middle and advanced stages of chronic severe hepatitis B. The factors in- fluencing the prognosis include hepatorenal syndrome, hepatic encephalopathy, alimentary tract hemorrhage and other serious com- plications, and the complications are interacted with each other. Therefore, the efficient control of the complications is one of the ways to improve the therapeutic effect on middle and advanced stages of chronic severe hepatitis B.