人工肝支持治疗下乙型肝炎相关慢加急性肝功能衰竭患者的近期预后分析

Analysis of short- term prognostic factors in patients with HBV- related acute- on- chronic liver failure treated with artificial liver support system

目的探讨人工肝治疗下乙型肝炎相关慢加急性肝功能衰竭的近期预后及其与HBeAg等各项临床检验指标之间的关系。为及时、准确判定乙型肝炎相关慢加急性肝功能衰竭预后提供参考。方法回顾性分析81例经体外人工肝支持及内科综合治疗乙型肝炎相关慢加急性肝功能衰竭患者(其中HBeAg阴性者55例,HBeAg阳性者26例)临床资料,分析不同HBeAg状态患者预后及各项检验指标(ALT、AST、TBil、白蛋白、前白蛋白、胆碱酯酶、凝血时间国际标准化比值、血氨、甲胎蛋白等)的差异。2组间比较采用卡方或非参数检验进行分析。结果 HBeAg阳性与阴性乙型肝炎相关慢加急性肝功能衰竭患者预后无明显差异(P=0.158),检验指标中前白蛋白、甲胎蛋白、国际标准化比值在治疗有效组与无效组之间有明显差异(P<0.000 1,P=0.000 5,P<0.000 1),进一步做ROC曲线,AUC值:前白蛋白,0.875;甲胎蛋白,0.795;国际标准化比值,0.792。结论人工肝支持治疗下HBeAg阳性与阴性乙型肝炎相关慢加急性肝功能衰竭患者预后无明显差异,前白蛋白、甲胎蛋白、凝血时间国际标准化比值作为乙型肝炎相关ACLF预后判断的指标具有一定准确性。

Objective To investigate the short - term prognosis in hepatitis B virus （HBV） - related acute - on - chronic liver failure （ACLF） treated with artificial liver support system （ALSS） and its relationship with clinical indices including HBeAg and to provide reference for the timely, accurate prognostic evaluation of HBV - related ACLF. Methods A retrospective analysis was performed on the clinical data of 81 patients with HBV - related ACLF （ 55 HBeAg - negative cases and 26 HBeAg - positive cases） who received ALSS treatment and comprehensive medical treatment. The HBeAg - negative cases and HBeAg - positive cases were compared in terms of treatment outcome and laboratory indices including alanine aminotransferase, total bilirubin, albumin, prealbumin （PA） , cholinesterase, international normalized ratio （INR） , blood ammonia, and alpha - fetoprotein （AFP）. Comparison between two groups was made by chi - square test or non - parametric test. Results There was no significant difference in treatment outcome between the HBeAg- negative cases and HBeAg- positive cases （P = 0. 158 ）. There were significant differences in PA, AFP, and INR between the patients with response to treatment and those without response to treatment （ P 〈 0. 000 1, P = 0. 000 5, and P 〈 0. 000 1 ）. The receiver operating characteristic （ROC） curves of PA, AFP, and INR were drawn, and their areas under the ROC curves were 0. 875,0. 795, and 0. 792, respectively. Conclusion There is no significant difference in treatment outcome between HBeAg - positive and HBeAg - negative patients with HBV - related ACLF treated with ALSS. PA, AFP, and INR can be used as accurate indices for prognostic evaluation of HBV -related ACLF.