未定病因肝衰竭患者的临床特点分析

Analysis of the clinical characteristics in patients with liver failure of unknown etiology

目的探讨未定病因肝衰竭的临床发病特点及其预后。方法回顾性分析解放军302医院2005年1月-2014年12月收治的326例未定病因肝衰竭住院患者的临床资料。结果未定病因肝衰竭的发病比例较高,占同期肝衰竭总数的6.50%,发病率仅次于HBV相关肝衰竭及酒精性肝衰竭。未定病因肝衰竭分型主要是亚急性肝衰竭（39.88%）,其次是慢加急性肝衰竭（36.50%）和急性肝衰竭（23.62%）,而其他类型肝衰竭（明确病因肝衰竭）主要分型是慢加急性肝衰竭（92.16%）。与我国最常见的HBV相关慢加急性肝衰竭比较,未定病因肝衰竭肝功能恶化程度更明显（ALT、AST、TBil更高,PTA更低）,ALP及白细胞平均水平也更高。未定病因肝衰竭好发于青中年患者（18~60岁,56.13%）,其次是青少年（〈18岁,28.53%）,老年患者（≥60岁）占15.34%。未定病因肝衰竭预后较差,总的治愈好转率仅占26.07%,青少年患者好转率为31.18%,青中年患者25.14%,老年患者20.00%。在3种类型肝衰竭分型中,以急性肝衰竭转归最差,好转率仅12.99%,亚急性肝衰竭好转率为34.62%,慢加急性肝衰竭好转率为25.21%。结论未定病因肝衰竭近年来发病比例增加,好发于青年及儿童,以亚急性肝衰竭多见,转归差。

Objective To investigate the clinical characteristics and prognosis in patients with liver failure of unknown etiology（LFUE）. Methods Clinical data of 326 LFUE patients in 302 Hospital of PLA from January 2005 to December 2014 were analyzed retrospectively. Results LFUE accounted for 6.50% of the total liver failure, and its incidence was lower than that of HBVrelated liver failure and alcohol-related liver failure. LFUE was presented mainly as subacute liver failure（39.88%）, followed by acuteon-chronic liver failure（36.50%） and acute liver failure（23.62%）, while other types of liver failure（known etiology） were presented mainly as acute-on-chronic liver failure（92.16%）. Compared with HBV-related acute-on-chronic liver failure, the deterioration of liver function in LFUE patients was worse（ALT, AST and TBIL were higher and PTA was lower）, ALP and the average level of white blood cells were also much higher. LFUE occurred mainly in adult patients（≥18 years, 60 years, accounting for 56.13%）, followed by adolescent patients（18 years old, accounting for 28.53%） and elderly patients（≥60 years old, accounting for 15.34%）. LFUE showed a poor prognosis. The overall improvement rate was only 26.07%, and improvement rate was 31.18%, 25.14% and 20.00% in adolescent patients, adult patients and elderly patients, respectively. In the three types of liver failure, improvement rate was12.99%, 34.62% and 25.21% for acute liver failure, sub-acute liver failure and acute-on-chronic liver failure patients, respectively. Conclusions The incidence of LFUE has been on the increase in recent 10 years, mainly presented as sub-acute liver failure, and it has a predilection for young adult and adolescents with a poor prognosis.