乙型肝炎慢加急性肝功能衰竭患者人工肝治疗的生存分析及其影响因素

Survival and its risk factors on the acute-on-chronic hepatitis B liver failure patients with artificial liver support system treatment

目的探讨人工肝治疗对乙型肝炎慢加急性肝功能衰竭患者生存率的影响及其影响因素。方法前瞻性选择2009年1月至2010年6月在福州市传染病医院住院的乙型肝炎慢加急性肝功能衰竭患者157例,根据患者意愿分成两组:治疗组93例,对照组64例。两组均给予内科综合治疗,治疗组加用人工肝治疗。记录两组基线时的临床基本资料,并进行随访。用Kaplan-Meier分别绘制两组整体及早、中、晚期患者生存曲线,Log-Rank检验生存率差异;应用Cox比例风险回归模型分析人工肝治疗患者生存时间的影响因素。结果两组整体、早期、中期患者的生存率差异无统计学意义(P>0.05),两组晚期患者的生存率差异有统计学意义(P<0.05);经过Cox比例风险回归模型单因素和多因素分析,年龄、肝性脑病、血清铁、胆碱酯酶、血钠是人工肝治疗患者生存时间的影响因素。结论人工肝能提高晚期乙型肝炎慢加急性肝功能衰竭患者的生存率;年龄、肝性脑病、高血清铁、低胆碱酯酶、低血钠是影响人工肝治疗患者预后的危险因素。

Objective To investigate the impact of survival time and risk factors of the acute-on-chronic hepatitis B liver failure patients with artificial liver support system（ALSS） treatment.Methods One hundred and fifty-seven acute-on-chronic hepatitis B liver failure patients in Fuzhou municipal infectious disease hospital from January 2009 to July 2010 were enrolled in the prospective study.According to the option of the patients,they were divided into two groups as follows： 93 cases in the treatment group,64 cases in the control group.All patients were given complicated therapy and patients in the treatment group were treated with ALSS.The clinical features were recorded at baseline and all patients were followed up.The survival curves of whole patients and patients in different stages in two groups were drawn respectively by the Kaplan-Meier.Survival rate was tested by Log-Rank.Results There was no significant difference between whole patients and patients in different stages of the two groups in the survival rate（P0.05）.The survival rate of the advanced stage in the treatment group was higher than that in the control group（P0.05）.Conclusion The artificial liver support system（ALSS） may improve the survival of the advanced stage acute-on-chronic hepatitis B liver failure patients.Age,hepatic encephalopathy,high serum iron,low CHE and low serum natrium are the risk factors to the prognosis of the patients who are treated with artificial liver support system.