脓毒血症诱发乙型肝炎相关慢加急性肝功能衰竭临床特征的研究

Clinical Characteristics of Acute-on-chronic Liver Failure in Patients with Hepatitis B-related Cirrhosis Precipitated by Sepsis

背景:目前脓毒血症作为诱因对乙型肝炎后肝硬化基础上发生的慢加急性肝功能衰竭(ACLF)的影响和预后尚无报道。目的:回顾性分析脓毒血症作为诱因对ACLF患者临床严重程度和短期死亡率的影响。方法:连续纳入2005年1月—2010年12月上海仁济医院HBV相关肝硬化合并急性失代偿的住院患者890例,以慢性肝功能衰竭联盟-器官功能衰竭评分(CLIF-C OFs)筛选出入院时为ACLF的患者。以脓毒血症作为诱因将ACLF患者分为脓毒血症诱因组和非脓毒血症诱因组,比较两组的基线资料、实验室检查、脏器衰竭发生率和短期病死率。结果:按照CLIF-C OFs标准入院时诊断为ACLF患者243例,其中脓毒血症为诱因的ACLF患者47例(19.3%),非脓毒血症为诱因者94例(38.7%),102例(42.0%)无明确诱因。脓毒血症诱因组和非脓毒血症诱因组的短期病死率均无明显差异(28 d:46.8%对36.2%,P=0.224;90 d:53.2%对42.6%,P=0.232)。与非脓毒血症诱因组相比,脓毒血症诱因组肝功能衰竭(72.3%对88.3%,P=0.030)和凝血障碍(53.2%对70.2%,P=0.046)的比例显著降低,而肾功能衰竭(48.9%对29.8%,P=0.026)和循环衰竭(14.9%对4.3%,P=0.042)的比例显著升高。结论:脓毒血症作为诱因的ACLF患者短期病死率与非脓毒血症诱因组相比无明显差异,但具有更高的肾脏、循环衰竭比例,而肝脏衰竭和凝血障碍发生率更低。

Background： The effect of sepsis on acute-on-chronic liver failure（ ACLF） in patients with hepatitis B-related cirrhosis and its prognosis have not been reported. Aims： To retrospectively analyze the effect of sepsis as a precipitating cause on clinical severity and short-term mortality of ACLF. Methods： A total of 890 hospitalized HBV-related cirrhosis patients with acute decompensation from Jan. 2005 to Dec. 2010 were enrolled. Patients with ACLF were diagnosed by Chronic Liver Failure-Consortium Organ Failure score（ CLIF-C OFs） at admission,and then were divided into sepsis（ precipitated） group and non-sepsis（ precipitated） group. Baseline data,laboratory examination,incidence of organ failure and short-term mortality were compared between the two groups. Results： According to CLIF-C OFs,243 patients were diagnosed as ACLF. Of them,47（ 19. 3%） patients were sepsis precipitated,94（ 38. 7%） patients were non-sepsis precipitated,and 102（ 42. 0%） patients had no clear precipitating events. No significant difference in short-term mortality was found between sepsis group and non-sepsis group（ 28-day mortality： 46. 8% vs. 36. 2%,P = 0. 224; 90-day mortality： 53. 2% vs. 42. 6%,P = 0. 232）. Compared with non-sepsis group,proportions of liver failure（ 72. 3% vs.88. 3%,P = 0. 030） and coagulation disorder（ 53. 2% vs. 70. 2%,P = 0. 046） were significantly decreased while proportions of renal failure（ 48. 9% vs. 29. 8%,P = 0. 026） and circulation failure（ 14. 9% vs. 4. 3%,P = 0. 042） weresignificantly increased in sepsis group. Conclusions： There is no significant difference in short-term mortality between sepsis group and non-sepsis group. However,ACLF patients precipitated by sepsis have a higher proportion of renal /circulation failure,and a lower proportion of liver failure and coagulation disorders.