江苏省南通地区2005年至2014年慢加急性肝功能衰竭流行病学调查分析

Epidemiological analysis of acute-on-chronic liver failure in Nantong, Jiangsu Province, 2005--2014

目的评估江苏南通地区慢加急性肝功能衰竭（ACLF）的发病率及短期病死率情况。方法系统收集2005年1月至2014年12月南通地区6家医院中新增ACLF患者的基本信息，ACLF诊断符合中华医学会肝病学分会制订的《肝功能衰竭诊疗指南》，对其性别、年龄、年发病率、原发病构成、急性加重原因及死亡原因等进行统计分析。结果2005年至2014年南通地区新发ACLF患者共1934例，男女比例约为3：1，各年龄组均有发病，35～54岁患者占56．0％；年发病率从3．4／10万下降至2．1／10万；原发病诊断前3位依次是CHB（91．0％）、自身免疫性肝病（3．0％）和酒精性肝病（2．7％）；患者28d病死率从2005年的50．4％下降至2014年的35．4％，其中合并肝硬化患者的病死率（58．6％）明显高于非肝硬化患者（32．8％）。结论南通地区ACLF患者以男性、青壮年为主，年发病率持续下降，原发病中以CHB为主，短期病死率呈现逐渐下降的趋势，年龄及肝硬化与病死率相关。

Objective To investigate the incidence rate and short-term mortality rate of acute onchronic liver failure （ACLF） in Nantong, Jiangsu Province. Methods The data of newly diagnosed ACLF cases from six public hospitals in Nantong city between January 1, 2005 and December 31, 2014 were collected. The diagnosis was made according to the criteria suggested by Chinese Society for Hepatology （CSH）. The sewage strueture, annual incidence rate, constituent ratio of primary disease, the causes of exacerbation and death were analyzed. Results During the ten-year period, a consecutive sample of 1 934 ACLF patients was included in this study. Male to female was 3 to 1. Patients covered all age groups. Yong patients were more frequent and 56.0% of them were aged 35 to 54 years old. The overall ACLF incidence rate decreased from 3.4 per 100 000 in 2005 to 2.1 per 100 000 in 2014. The three commonest causes of ACLF were chronic hepatitis B （CHB） （91.0%） , autoimmune liver diseases （AILD） （3.0%） and alcoholic liver diseases （ALD） （2.7 % ）. The 28-day mortality rate of the ACLF patients had a decline during the study period, form 50. 4% in 2005 to 35. 4% in 2014. The mortality rate was remarkablely higher for those who had been diagnosed with cirrhosis compared with those who had not （697/1 189, 58.6% vs 244/745, 32. 8%）. Conclusions In Nantong area, ACLF is more frequent in young male patients. The annual incidence rate of ACLF is decreasing. CHB is the main cause of ACLF. The shortterm mortality of ACLF is decreasing, and mortality is associated with the presence of cirrhosis and older age.