3233例急性、亚急性、慢加急性肝衰竭病因特点分析

Etiological Analysis of 3233 Patients with Acute Liver Failure, Subacute Liver Failure and Acute-on-chronic Liver Failure

目的探讨北方地区急性肝衰竭(ALF)、亚急性(SALF)、慢加急性肝衰竭(ACLF)的病因及其特点。方法回顾性总结我院收治的3233例肝衰竭患者临床资料,对病因、年龄等方面进行比较分析。结果 3233例患者中,ALF前三位的病因是:HEV(22.52%)、药物性(18.92%)、HBV(17.12%),SALF为药物性(29.15%)、HEV(14.57%)、HBV(10.55%),而ACLF为HBV(87.75%)、酒精性(3.87%)、HBV重叠HEV(1.64%)。常见嗜肝病毒感染者占总数86.20%(2787例),其中仅单一HBV感染者共2605例,占ACLF的87.75%,占总数的80.56%;其中35～65岁人占76.33%。HEV感染导致肝衰竭呈下降趋势;酒精性及药物性发病呈明显上升趋势。HAV单独或重叠感染至肝衰竭病例数最少。结论 3233例患者中不同类型肝衰竭主要病因不同;HBV感染居LF病因之首,酒精性、药物性LF呈上升趋势。

Objective To investigate etiology of 3 233 patients with acute liver failure, subacute liver failure and acute-on-chronic liver failure coming from North China. Methods The clinical data of 3 233 patients with liver failure were retrospectively analysed, including etiopathogenisis, ages. Results Of the 3 233 cases, the three predominant causes of ALF were HEV（22.52%）, drug （18.92%）, HBV （17.12%）, and the three predominant causes of SALF were drug（29.15%）, HEV（14.57%）, HBV（10.55%）, but those of the ACLF were HBV （87.75%）, alcohol （3.87%）, HBV superinfection HEV（1.64%）. 86.20% （2787） patients were infected by hepatotropic virus. The first cause of liver failure was HBV（87.75% of ACLF, 80.56% of 3 233 patients）. In these HBV infected patients, 76.33% were from 35 to 65 years old. Ratio of patients with HEV infection decreased, but ratio of patients with drug or alcohol increased. The number of HAV infection was least. Conclusion Different types of liver failure have different predominant causes. HBV infection is the most common cause in 3 233 patients. The number of drujz- induced liver failure and alcoholic liver failure is increasing.