253例乙型肝炎病毒引起的慢加急性肝衰竭预后影响因素分析

Analysis on prognostic factors in 253 cases of acute-on-chronic liver failure caused by hepatitis B virus

目的探讨乙型肝炎病毒引起的慢加急性肝衰竭(ACLF)患者预后的影响因素。方法根据预后将253例ACLF患者分为治疗有效组(84例)和无效组(169例),统计患者的一般资料、常规化验指标、肝功能指标和乙肝病毒学指标,回归分析各项指标与预后的关系。结果有效组和无效组性别、ALT、AST、前白蛋白、总胆固醇、血糖、AFP、血红蛋白、血小板、HBV DNA计量和e抗原(HBeAg)阳性率在两组间差异均无统计学意义(均P>0.05);有效组和无效组年龄、总胆红素水平、白蛋白、肌酐、凝血酶原活动度、纤维蛋白原和住院时间差异有统计学意义(P均<0.05)。患者年龄越大,预后越差(χ2=9.426,P<0.05)。Logistic多元回归分析表明,总胆红素、PTA、纤维蛋白原、肌酐和住院时间是ACLF的独立影响因素(P均<0.05)。结论年龄、血清总胆红素、白蛋白、肌酐、凝血酶原活动度、纤维蛋白原和住院时间影响乙型肝炎病毒引起的慢加急性肝衰竭患者的预后,其中总胆红素、PTA、纤维蛋白原、肌酐、住院时间影响显著。

Objective To explore prognostic factors in cases of acute-on-chronic liver failure （ACLF） caused by hepatitis B virus. Methods Two hundred and fifty-three patients with ACLF caused by hepatitis B virus were divided into responders （84 patients） and non-responders （169 patients）. General patient information, routine laboratory results, liver function results, and data on serum indicators of hepatitis B virus were collected and analyzed. A student＇s t-test was used to evaluate data with a normal distribution, and a chi-square test was used for categorical variables. The independent risk factors for prognosis were determined using binary logistic regression analysis, and P〈0.05 was deemed to indicate a statistical difference. Data were processed using SPSS 18.0 （for Windows） statistical software. Results Differences between responders and non-responders in terms of gender, serum alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, pre-albumin, total cholesterol, glucose, alpha fetoprotein （AFP）, hemoglobin, platelets, levels of hepatitis B virus （HBV） DNA, and HBeAg results were not statistically significant （P〉0.05）. Differences between responders and non-responders in terms of age, total bilirubin, albumin, creatinine, prothrombin activity, fibrinogen, and the duration of hospitalization were significant （P〈0.05）. Older patients had a worse prognosis （X^2 = 9. 426, P〈0.05）. Logistic regression analysis indicated that total bilirubin, prothrombin activity, fibrinogen, creatinine, and hospitalization time were independent factors for prognosis （P〈0.05）. Conclusion Age, total bilirubin, albumin, creatinine, prothrombin activity, fibrinogen, and the duration of hospitalization affected the prognosis of patients with ACLF caused by hepatitis B. Total bilirubin, prothrombin activity, fibrinogen, creatinine, and hospitalization time have significantly effect on the prognosis and could be the independent factors for prognosis.