慢加急性肝衰竭与慢性肝衰竭临床特征对比性分析

Comparative study on clinical features of patients with acute-on-chronic liver failure and chronic liver failure

目的了解慢加急性肝衰竭(ACLF)与慢性肝衰竭(CLF)的临床特征及预后差异。方法 103例慢性重型肝炎患者按肝衰竭诊疗指南分为ACLF组(35例)和CLF组(68例),比较两组临床及实验室指标、常见并发症、MELD评分及预后。结果 CLF在慢性重型肝炎中占66.02%(68/103),患者年龄较大、病程较长;两组在血常规参数(WBC、HB、PLT、MPV)和凝血指标(PT、APTT、TT)均有差异(P<0.05,P<0.01);ACLF组肝功能AST、ALT、TBIL、ALB高于CLF组,GLO、TBA低于CLF组(P<0.05,P<0.01);两组腹水和肝性脑病发生率差异有统计学意义(P<0.01);ACLF组MELD分值低于CLF组,其预后优于CLF组(P<0.05,P<0.01)。结论 ACLF和CLF在好发年龄、病程、血常规参数、凝血功能、肝功能指标、并发症腹水和肝性脑病发生率、MELD评分及预后均有差异。肝衰竭指南符合国情,有重要的临床应用价值。

Objective To investigate the clinical features and prognostic difference between acute-on-chronic liver failure （ACLF） and chronic liver failure （CLF）. Methods 103 patients with chronic severe hepatitis were classified to ACLF group （n = 35） and CLF group （n = 68） according to 〝Diagnosis and treatment guideline for liver failure〞. The clinical and laboratory parameters, complications, MELD score and prognosis of the two groups were compared. Results CLF accounted for 66.02% （68/103） in chronic severe hepatitis. Compared with ACLF patients, CLF patients were older in age and longer in course of disease. There were significant differences in the blood parameters （WBC, HB, PLT, MPV） and coagulation paramaters （PT, APTT, TT） between the two groups （P 〈0.05, P 〈0.01）. AST, ALT, TBil, ALB were higher and GLO, TBA were lower in ACLF group than those in CLF group （P 〈 0.05, P 〈 0.01 ）. There were statistically significant differences in the incident rates of complications including ascites and hepatic enceph- alopathy between the two groups （P 〈 0.01 ）. MELD score was lower and prognosis was better in ACLF group than those in CLF group （P 〈 0.05, P 〈 0.01 ）. Conclusion There are significant differences in age, course of disease, blood routine parameters, coagulation, liver function, incident rates of ascites and hepatic encephalopathy, MELD score and prognosis between ACLF and CLF patients. The guideline for liver failure has the important clinical value for Chinese.