乙型肝炎患者并发慢加急性肝衰竭发病诱因及临床预后分析

Analysis the predisposing factors and clinical prognosis of Hepatitis B patients with acute on chronic liver failure

目的分析乙型肝炎并发慢加急性肝衰竭（ACLF）的发病诱因、临床特征及其临床预后的影响因素，探讨影响慢性乙型肝炎肝衰竭患者预后的危险因素。方法将260例乙型肝炎并发慢加急性肝衰竭患者分为治愈好转组和无效病死组，并对其发病诱因、临床特征及其临床预后的影响因素进行分析。结果260例乙型慢加急性肝衰竭患者，治愈好转组109例，好转率为41．92％，无效病死组151例，总死亡率为58．08％；年龄和性别对病死率无明显影响。慢加急性肝衰竭最主要的诱因依次为HBV活动及变异（51．53％）、非病毒性感染（23．08％）、消化道出血（11．10％）和其他（14．29％）；两组患者血清生化指标中凝血酶原活动度、低钠血症比较差异有统计学意义（P〈0．01）。结论乙型肝炎并发慢加急性肝衰竭的临床过程复杂，其预后与诱因、并发症以及反映病情程度的生化指标等改变明显相关。

Objective To analyze the influencing factors on incentives, clinical characteristics and prognosis in hepatitis B patients complicated with acute on chronic liver failure,, and explore the risk factors affecting on its prognosis. Methods 260 patients with hepatitis B complicated with acute on chronic liver failure were divided into two groups：improved group and death group, clinical data including predisposing factors, clinical characteristics and clinical prognostic factors were analyzed. Results Of 260 patients with type B acute on chronic liver failure, 109 patients were in improved group,improvement rate was 41.92% ,151 patients were in death group and total mortality rate was 58.08% ;age and gender had no significant effect on mortality ; The main incentives of acute on chronic liver failure were ： activity and variation of HBV （51.53% ）, non-viral infection（ 23.08% ） , gastrointestinal bleeding（ 11.10% ） and others（ 14.29% ）;The differences of serum biochemical indicators such as prothrombin activity and hyponatremia between these 2 groups were significant. Conclusion The clinical course of hepatitis B with acute on chronic liver failure is complicated, and its prognosis is related to incentives, complications, and biochemical markers which can reflect the severity of the disease.