623例老年肝衰竭病因学及预后分析

Analysis of etiology and prognosis of liver failure in 623 elderly patients

目的回顾性分析老年肝衰竭患者的临床特征。方法收集解放军302医院2003年1月—2013年12月收治的623例老年肝衰竭患者与同期收治的3791例中青年肝衰竭患者的临床资料,分析老年肝衰竭患者病因学及预后等方面的临床特征。结果老年肝衰竭占全部肝衰竭患者的比例在2003年为13.21%,2013年为16.01%。导致老年肝衰竭的前5位病因依次为:HBV相关肝衰竭(68.06%)、不明原因肝衰竭(7.22%)、HCV相关肝衰竭(5.30%)、HEV相关肝衰竭(4.98%)、药物相关性肝衰竭(4.65%)。两组均以慢加急性肝衰竭为主(85.23%vs 90.56%)。HEV相关肝衰竭在急性、亚急性老年肝衰竭中最常见(33.33%、33.80%),高于青中年组急性、亚急性戊型肝衰竭的比例(7.77%,12.94%,P<0.05)。老年组肝衰竭患者治疗好转率为25.20%,低于青中年组的治疗好转率(41.78%,P<0.01)。结论我国老年肝衰竭患者主要以慢加急性肝衰竭为主,在急性、亚急性肝衰竭中以HEV相关肝衰竭最常见。老年肝衰竭转归较青中年差。

Objective To study the clinical characteristics of elderly patients with liver failure. Methods The clinical data of 623 elderly patients with liver failure from Jan. 2003 to Dec. 2013 in 302 Hospital of Chinese PLA were collected, and other 3791 young adult patients with liver failure during the same period were also collected as control group. The etiology and prognosis of elderly patients with liver failure were analyzed retrospectively. Results Elderly patients with liver failure accounted for 13.21% of the total number of liver failure patients in 2003, and 16.01% in 2013. The most frequent causes leading to liver failure were, in order of frequency, hepatitis B（68.06%）, unknown causes （7.22%）, hepatitis C （5.30%）, hepatitis E （4.98%） and drug （4.65%）. Acute or chronic liver failure （85.23% vs 90.56%） was the main type in the two groups. HEV infection-induced liver failure in elderly patients was the predominant cause of acute and subacute liver failure, accounting for 33.33% and 33.80% respectively in acute and subacute liver failure patients, which were significantly higher than that in the young adult group （7.77% and 12.94% respectively, P〈0.05）. 157 elderly patients （25.20%） showed improvement from liver failure, while 1584 （41.78%） young patients showed improvement, the difference was significant （P〈0.01）. Conclusions Acute/chronic liver failure is the main type of liver failure in elderly patients. HEV infection is the most common cause leading to acute/subacute liver failure. The elderly patients with liver failure have a much poorer prognosis than that of the young adult.