HBV与HEV重叠感染致慢加急性肝衰竭临床特征分析

Clinical features of patients with superinfection of HEV and HBV related acute on chronic liver failure

目的研究乙型肝炎病毒(HBV)与戊型肝炎病毒(HEV)重叠感染致慢加急性肝衰竭(ACLF)的临床特征。方法回顾性分析HBV与HEV重叠感染致ACLF患者35例(重叠感染组);并筛选同期单纯HBV感染致ACLF患者37例作为对照(单纯HBV感染组)。比较两组患者肝肾功能、HBV DNA水平、血小板计数(PBC)、凝血功能、终末期肝病模型(MELD)评分及预后情况。比较重叠感染组存活和死亡患者临床特点,二分类非条件Logistic回归分析与HBV及HEV重叠感染预后相关的因素。结果与单纯HBV感染组比较,重叠感染组患者总胆红素(TBIL)、MELD评分、肝性脑病发生率和24周病死率明显升高,凝血酶原活动度(PTA)明显降低,差异有统计学意义(P<0.05)。与重叠感染组存活患者比较,重叠感染组死亡患者肌酐(Cr)、MELD评分和肝性脑病发生率明显升高,PTA明显降低,差异有统计学意义(P<0.05)。TBIL(P=0.024,OR=1.006)、血小板计数(P=0.019,OR=0.983)、PTA(P=0.001,OR=0.795)、MELD评分(P=0.005,OR=1.497)及并发症肝性脑病(P=0.001,OR=4.147)与预后相关。结论 HBV与HEV重叠感染致ACLF患者病情更加严重,预后更差。TBIL、MELD评分及肝性脑病发生率越高,血小板计数和PTA越低,患者预后越差。

Objective To investigate the clinical features of patients with superinfection of HEV and HBV related acute on chro-nic liver failure（ACLF） .Methods Clinical data of 35 patients diagnosed with superinfection of HEV and HBV related ACLF and 37 patients diagnosed with HBV related ACLF were collected for this retrospective study .The liver and kidney function ,HBV DNA level ,blood platelet count（BPC） ,coagulation function ,model for end-stage liver disease（MELD）score and mortality at 24 weeks were analyzed .Furthermore ,comparison of the clinical data between the survival patients and died patients in superinfection group was made .Unconditioned binary response logistic regression model was used to determine the corresponding risk factors .Results The level of total bilirubin（TBIL） ,MELD score ,incidence rate of hepatic encephalopathy and mortality at 24 weeks were signifi-cantly higher and prothrombin activity（PTA）was significantly lower in superinfection patients（P〈0.05） .The level of serum creat-inine（Cr） ,MELD score and incidence rate of hepatic encephalopathy were significantly higher and PTA was significantly lower in died patients than that of superinfection group（P〈 0.05） .Logistic regression analysis identified TBIL（P= 0.024 ,OR= 1 .006） , BPC（P=0.019 ,OR=0.983） ,PTA（P=0.001 ,OR=0.795） ,MELD score（P=0.005 ,OR=1 .497）and hepatic encephalopathy（P=0.001 ,OR=4 .147）as prognostic factors for patients with superinfection of HEV and HBV related ACLF .Conclusion The clini-cal features of patients with superinfection of HEV and HBV related ACLF were more serious .The higher level of TBIL ,MELD score and hepatic encephalopathy and the lower level of BPC and PTA ,the worse prognosis .