陕西地区肝衰竭病因构成及变迁特点分析

Composition and changing trend of the etiologies of liver failure in Shaanxi Province,China

目的 探讨陕西地区肝衰竭的病因构成及变迁特点。方法 回顾性收集2008年1月-2017年12月在西安交通大学第一附属医院住院的来自陕西省的975例肝衰竭患者的临床资料并进行分析。根据肝衰竭临床类型,分为急性肝衰竭(ALF)(n=115)、亚急性肝衰竭(SALF)(n=165)及慢加急性肝衰竭(ACLF)(n=695)3组。计量资料多组间比较采用单因素方差分析,两组间比较采用t检验;计数资料组间比较采用χ^2检验。结果 ALF的首要病因为药物(25.22%,29/115),其次为HBV感染(21.74%,25/115);SALF的首要病因为HBV感染(35.15%,58/165),其次为药物(27.27%,45/165);ACLF的首要病因为HBV感染(87.19%,606/695),其次为酒精(3.45%,24/695)。HBV感染、酒精性及药物性肝衰竭患者的年龄分布区间主要以20~60岁(595/689)、30~40岁(22/32)及30~70岁(67/89)为主。近5年HBV感染相关的肝衰竭比例较前5年显著下降(61.52% vs 81.33%,χ^2=45.87,P<0.001);药物性及酒精性肝衰竭的发病率较前5年显著升高(药物:13.14% vs 4.44%,χ^2=22.10,P<0.001;酒精:4.76% vs 1.56%,χ^2=7.85,P=0.005)。进一步分析发现近5年HBV相关肝衰竭发病年龄显著高于前5年患者发病年龄[(45.3±13.0)岁 vs (42.5±12.9)岁,t=-2.567,P=0.011]。结论 慢性HBV感染的管理仍然是控制肝衰竭的重要环节,同时需加强药物性及酒精性肝病的防治,高龄肝衰竭患者的救治需重视。

Objective To investigate the composition and changing trend of the etiologies of liver failure in Shaanxi Province, China. Methods A retrospective analysis was performed for the clinical data of 975 patients with liver failure who were hospitalized in The First Affiliated Hospital of Xi’an Jiaotong University from January 2008 to December 2017. According to the clinical type of liver failure, the patients were divided into acute liver failure (ALF) group with 115 patients, subacute liver failure (SALF) group with 165 patients, and acute-on-chronic liver failure (ACLF) group with 695 patients. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the t-test was used for further comparison between two groups;the chi-square test was used for comparison of categorical data between groups. Results Drug was the primary cause of ALF (25.22%, 29/115), followed by hepatitis B virus (HBV) infection (21.74%, 25/115);HBV infection was the primary cause of SALF (35.15%, 58/165), followed by drug (27.27%, 45/165);HBV infection was the primary cause of ACLF (87.19%, 606/695), followed by alcohol (3.45%, 24/695). The main age distribution of patients with liver failure due to HBV infection, alcohol, and drug was 20-60 years (595/689), 30-40 years (22/32), and 30-70 years (67/89), respectively. There was a significant reduction in the proportion of patients with HBV-related liver failure in the recent 5 years (61.52% vs 81.33%, χ^2=45.87, P<0.001), while there were significant increases in the proportion of patients with drug-induced liver failure (13.14% vs 4.44%, χ^2=22.10, P<0.001) and alcoholic liver failure (4.76% vs 1.56%, χ^2=7.85, P=0.005). Further analysis showed that the age of onset of HBV-related liver failure in the recent 5 years was significantly higher than that in the first 5 years (45.3±13.0 vs 42.5±12.9, t=-2.567, P=0.011). Conclusion Management of chronic HBV infection is still an important link in the control of liver failure, and meanwhile, the prevention and treatment of drug-induced and alcoholic liver diseases should be strengthened. More attention should be paid to the treatment of elderly patients with liver failure.