乙型肝炎病毒相关慢加急性肝衰竭恢复患者的长期预后

Long-term outcomes and prognostic risk factors in patients recovered from hepatitis B virus related acute-on-chronic liver failure

目的 研究乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）恢复患者的长期预后.方法 对我院2005年1月-2009年12月住院HBV-ACLF恢复患者进行72个月随访,以首次诊断ACLF的时间为基线,根据基线时影像学检查结果,将患者分为乙型肝炎肝硬化ACLF（HBC-ACLF）组和慢性乙型肝炎ACLF（CHB-ACLF）组.观察恢复后患者发生肝硬化、肝硬化失代偿、再次发生ACLF以及原发性肝癌（HCC）等不良事件的情况.结果 CHB-ACLF患者恢复后进展至肝硬化的中位时间为12.5个月,至肝硬化失代偿的中位时间为23个月,至HCC发生的中位时间为43个月;而LC-ACLF患者至肝硬化失代偿及HCC发生的中位时间分别是7个月、14个月,显著短于CHB-ACLF患者（P=0.009、0.040）,差异有统计学意义.血清白蛋白（ALB）、胆碱酯酶（CHE）以及总胆固醇（TC）、甘油三酯（TG）,血小板计数（PLT）、HBV病毒变异、病毒复发与临床终点事件发生明显相关,P值均〈0.05.Logistic回归结果发现,患者年龄、起病前有无肝硬化基础、HBV病毒变异、病毒复发是影响HBV-ACLF患者长期预后的独立危险因素,OR分别为1.035、0.510、2.462,P〈0.05.入院时LC-ACLF患者累积发生肝硬化失代偿、ACLF及HCC的危险显著高于CHB-ACLF患者,P=0.000、0.035.结论 起病前有无肝硬化基础以及患者对抗病毒治疗的依从性和抗病毒治疗中发生病毒变异影响HBV-ACLF患者长期预后,加强对HBV-ACLF患者抗病毒治疗中病毒变异的监测、提高患者治疗的依从性,对改善ACLF患者长期预后极为重要.

Objective To study the long-term prognosis of the convalescent patients with hepatitis B virus （HBV） associated acute-on-chronic liver failure （HBV-ACLF）.Methods A 72-month follow-up study of HBV-ACLF recovery patients recruited between January 2005 and December 2009 was performed in our hospital.According to the results of imaging examination at the first visit, the enrolled patients were divided into two groups, the liver cirrhosis ACLF （Lc-ACLF） group and chronic hepatitis B related ACLF （CHB-ACLF） group.In both groups, the occurrence of cirrhosis, decompensated cirrhosis or ACLF and hepatocellular carcinoma （HCC） were observed.Results The media time of cirrhosis formation, decompensated cirrhosis and HCC occurrence in CHB-ACLF group were 12.5, 23 and 43 months, respectively.However, the median time of LC-ACLF patients developing to decompensated cirrhosis and HCC were 7 and 14 months, which was significantly shorter than that in CHB-ACLF group （P=0.009, 0.040, with statistical significance）.Furthermore, the blood chemical parameters including serum albumin （ALB）, cholinesterase （CHE） and total cholesterol （TC）, triglyceride （TG）, as well as platelet count （PLT）, the anti-viral treatment compliance and the virus mutation were significantly related to the clinical endpoint events, respectively （P〈0.05）.Moreover, results from the logistic regression model demonstrated that the patient age, with or without liver cirrhosis, HBV mutation and the anti-viral treatment compliance were the independent risk factors for the long-term prognosis of patients with hepatitis B associated liver failure （OR=1.035, 0.510, 2.462, respectively.P〈 0.05）.The cumulative risk of Lc-ACLF patients progressed to decompensate cirrhosis, acute-on-chronic liver failure or HCC was significantly higher than that of CHB-ACLF patients （x2=21.603, 4.423, P=0.000,0.035, respectively）.ConclusionsConsidering the importance of patients with or without liver cirrhosis, HBV mutation and the anti-viral treatment compliance in the long-term prognosis of HBV-ACLF patients, it is necessary and important to monitor the virus mutation and anti-viral treatment compliance of HBV-ACLF patients during antiviral therapy and those processes would benefit the improvement of long term prognosis of the patients with ACLF.