乙型肝炎慢加急性肝衰竭患者短期预后的生存分析

Survival analysis of short-term prognosis of patients with HBV-related acute-on-chronic liver failure

目的 探讨影响乙型肝炎慢加急性肝衰竭患者短期生存时间及预后的独立危险因素.方法总结首都医科大学附属北京地坛医院2007年1月至2010年12月338例乙型肝炎相关慢加急性肝衰竭患者的临床资料,观察影响患者短期生存时间及预后的危险因素,运用Cox回归模型进行单因素和多因素生存分析.结果 Cox回归模型分析显示,消化道出血、肝肾综合征、电解质紊乱、肝性脑病可显著增加患者的近期死亡风险,相对危险度[Exp（β）]分别为2.526、2.356、2.068和1.896,凝血酶原活动度升高[Exp（β）为0.821]及早、中期抗病毒治疗[早期Exp（β）为0.526,中期Exp（β）为0.601]是降低患者病死率的保护因素.结论 消化道出血、肝肾综合征、电解质紊乱、肝性脑病、凝血酶原活动度及抗病毒治疗时机是影响患者生存时间的独立危险因素,将MELD评分与多因素分析相结合是判断慢加急性肝衰竭预后较为科学的方法.

Objective To investigate the independent risk factors of influencing short-term survival and prognosis of patients with HBV-related acute-on-chronic liver failure （ HBV-ACLF）.Methods The clinical data of 338 HBV-ACLF patients hospitalized from January 2007 to December 2010 were collected and analyzed by a Cox regression model.Results The Cox regression analysis showed than gastrointestinal hemorrhage,hepatorenal syndrome,electrolyte imbalance and hepatic encephalopathy could significantly increase their recent mortality risks.And the values of relative risk （RR） were 2.526,2.356,2.068 and 1.896 respectively.Prothrombin activity （ Exp （β）：0.821 ） and opportunity of antiviral therapy （Exp（β） of early stage： 0.526; Exp （β） of medium stage： 0.601 ） were protective factors of reduced mortality.Conclusion Gastrointestinal hemorrhage,hepatorenal syndrome,electrolyte imbalance,hepatic encephalopathy,prothrombin activity and opportunity of antiviral therapy are independent risk factors of influencing short-term survival and prognosis of HBV-ACLF patients.The combination of MELD score and multivariate analysis is a more scientific method of determining the prognosis of HBV-related ACLF.