HBV合并HEV感染对慢加急性肝衰竭皮质醇、免疫指标及预后的影响

Cortisol,immune indexes and prognosis in patients with HBV and HEV related acute on chronic liver failure

目的探讨乙肝病毒(HBV)合并戊肝病毒(HEV)感染对慢加急性肝衰竭(ACLF)皮质醇、免疫指标及预后的影响,为其临床研究提供参考依据。方法选择2012年3月-2015年11月68例单纯HBV感染致ACLF患者为HBV组及59例HBV合并HEV重叠感染致ACLF患者为重叠组,空腹抽取静脉血检测外周血中皮质醇,γ干扰素,IP-10水平及肝功能指标;随访6个月分析两组生存情况,并分析影响预后的因素。结果重叠组皮质醇水平低于HBV组,而γ干扰素、IP-10水平高于HBV组,差异有统计学意义(P<0.05);随访6个月,重叠组患者死亡29例,HBV组患者死亡15例,差异有统计学意义(P<0.05)。结论 HBV合并HEV重叠感染导致ACLF肝脏损失更大,病死率更高,PTA越低,MELD评分及Child-Pugh评分越高,患者预后越差。

OBJECTIVE To investigate the cortisol,immune indexes and prognosis in patients with HBV and HEV related acute on chronic liver failure,so as to provide references for clinical research.METHODS A total of 68 patients with HBV infection causing ACLF（HBV group）and 59 patients with HBV overlapping combined HEV infection causing ACLF（overlapping group）were selected from Mar.2012 to Nov.2015.Fasting venous blood was extracted for the detection of peripheral blood cortisol,γ-interferon,IP-10 level and liver function indexes.The survival situation were analyzed followed up for 6 months,and the factors influencing prognosis were analyzed.RESULTS The cortisol level in overlapping group was lower than that in HBV group.Theγ-interferon and IP-10 levels in overlapping group were higher than those in HBV group.The differences were significant（P〈0.05）.There were 29 patients in overlapping group were died followed up for 6 months,which were higher than 15 in HBV group.The difference was significant（P〈0.05）.CONCLUSION The clinical features of patients with superinfection of HEV and HBV related ACLF were more serious.The higher level of MELD score and Child-Pugh score and the lower level of PTA,the worse prognosis.