基于世界胃肠病学大会提议的HBV相关慢加急性肝衰竭的临床特征及分型探讨

Clinical features and typing of hepatitis B virus-related acute-on-chronic liver failure based on recommendations of the World Congress of Gastroenterology

目的探讨不同分型的HBV相关慢加急性肝衰竭患者临床特征及预后情况。方法回顾性分析解放军第三○二医院2016年1月-2016年12月收治的296例基于世界胃肠病学大会提议的HBV相关慢加急性肝衰竭患者的临床资料,根据发病基础分为A型(慢性肝炎组,n=53)、B型(代偿期肝硬化组,n=151)、C型(失代偿期肝硬化组,n=92)。对3组患者的实验室指标、合并症发生率及预后进行分析。多组间计量资料比较服从正态分布且方差齐的采用方差分析,进一步两两比较采用LSD-t检验,不服从正态分布或方差不齐的采用Kruskal-Wallis H检验;计数资料比较采用Pearsonχ~2检验。结果 3组间Alb、ALT、胆碱酯酶(Ch E)及AFP水平两两比较差异均有统计学意义(P值均<0.05),A型最高,其次是B型,C型最低;对于AST、PLT,A型最高,分别与B型和C型两两比较,差异均有统计学意义(P值均<0.05)。对于总胆固醇(TCHO),A型和B型患者均高于C型患者(P值均<0.05)。腹水或胸水(69.81%vs 88.08%vs 90.22%)、肝肾综合征(18.87%vs 28.48%vs 43.48%)在C型患者中更易出现,3组间发生率比较差异均有统计学意义(χ~2值分别为12.964、10.691,P值均<0.05);B型和C型患者更易出现腹膜炎,3组间比较差异有统计学意义(22.64%vs 40.40%vs 48.91%,χ~2=9.718,P<0.05)。A、B、C 3组患者的好转率差异有统计学意义(52.83%vs45.70%vs 32.61%,χ~2=6.593,P<0.05)。结论 HBV相关慢性肝炎、代偿期肝硬化、失代偿期肝硬化基础上出现的慢加急性肝衰竭患者在生化指标、合并症及预后方面均存在差异,依此分型有利于探索相应的治疗措施和进行预后评估。

Objective To investigate the clinical features and prognosis of patients with different types of hepatitis B virus-related acute-on-chronic liver failure（ HBV-ACLF）. Methods A retrospective analysis was performed for the clinical data of 296 patients with HBV-ACLF who were admitted to 302 Hospital of PLA from January to December,2016 and diagnosed based on recommendations of the World Congress of Gastroenterology,and according to the pathogenesis,these patients were divided into chronic hepatitis group（ type A group with 53 patients）,compensated cirrhosis group（ type B group with 151 patients）,and decompensated cirrhosis group（ type C group with 92 patients）. Laboratory markers,incidence of comorbidities,and prognosis were analyzed for all groups. An analysis of variance was used for comparison of normally distributed continuous data with homogeneity of variance between multiple groups,and the least significant difference t-test was used for further comparison between two groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data or continuous data with heterogeneity of variance between groups. The Pearson＇s chi-square test was used for comparison of categorical data between groups. Results There were significant differences in albumin,alanine aminotransferase,and cholinesterase between the three groups（ all P 0. 05）,and the type A group had the highest levels,followed by the type B group and the type C group.The type A group had significantly higher levels of aspartate aminotransferase and platelet count than the type B group and the type C group（ all P 0. 05）. The type A group and the type B group had a significantly higher level of total cholesterol than the type C group（ both P 0. 05）. Compared with the type A group and the type B group,the type C group had significantly higher incidence rates of ascites/pleural effusion（ 90. 22% vs 69. 81%/88. 08%,χ~2= 12. 964,P 0. 05） and hepatorenal syndrome（ 43. 48% vs 18. 87%/28. 48%,χ~2= 10. 691,P 0. 05）. The type B group and type C group had a significantly higher incidence rate of peritonitis than the type A group（ 40. 40%/48. 91% vs 22. 64%,χ~2= 9. 718,P 0. 05）. There was a significant difference in improvement rate between the three groups（ 52. 83% vs 45. 70% vs 32. 61%,χ~2= 6. 593,P 0. 05）. Conclusion There are significant differences in biochemical parameters,comorbidities,and prognosis between HBV-ACLF patients with HBV-related chronic hepatitis,compensated cirrhosis,and decompensated cirrhosis.Such a typing method helps to explore treatment measures and assess prognosis.