慢性乙型肝炎患者停药导致肝衰竭发生的特征及影响预后的相关因素分析

An analysis of the characteristics and the prognostic impact factors of liver failure caused by drug withdrawal in chronic hepatitis B patients

目的探讨慢性乙型肝炎患者停药导致肝衰竭发生的特征及影响预后的相关因素分析。方法研究对象选取2015年1月至2020年1月间由于停药导致肝衰竭的慢性乙型肝炎患者106例,依据第12周的存活情况分为生存组47例和死亡组59例。收集两组患者的基线资料、治疗方案、生化指标、病毒量等临床资料,比较两组患者临床特征差异,并对影响预后的相关因素进行分析。采用t检验对正态分布的计量资料进行比较;采用Mann-Whitney U检验对偏态分布的计量资料进行比较;采用χ^(2)检验对计数资料进行比较;采用Logistic回归对影响预后的相关因素进行分析。结果死亡组患者肝硬化发生率为88.14%(52/59),生存组患者肝硬化发生率为18.75%(9/48),两组比较差异显著(P<0.05)。生存组患者白蛋白、γ-谷氨酰转肽酶、胆碱酯酶水平均显著高于死亡组,生存组总胆红素、凝血酶原时间、国际标准化比值、MELD评分均显著低于死亡组,差异均显著(P<0.05)。两组患者ACLF分级比较,差异显著(P<0.05)。采用Logistic回归对影响预后的相关因素进行分析。提示:ACLF分级和肝硬化是影响预后的独立预测因素。结论肝硬化患者停药后,引起肝功能衰竭的风险较高,一旦进展为肝衰竭,患者病死率较高。同时,慢性乙型肝炎停药导致肝衰竭的临床转归,取决于ACLF分级与是否合并肝硬化。

Objective To investigate the characteristics of liver failure caused by discontinuation of antiviral drugs in chronic hepatitis B(CHB)patients and analysis the impact factors affecting prognosis.Methods One hundred and six chronic hepatitis B patients who were admitted to Shiyan People′s Hospital from January 2015 to January 2020 were enrolled in this study.They were all suffered from liver failure due to withdrawal of anti-viral drugs.Based on their survival situation at the 12th week,they were divided into survival group(N=47 cases)and death group(N=59 cases).The baseline data,treatment plan,biochemical indicators,viral load and other clinical data of both groups of patients were collected.The clinical characteristics of these two groups of patients were compared and analyzed for the impact factors affecting prognosis.T-test was used to compare the measurement data of the normal distribution;Mann-Whitney U test was used to compare the measurement data of the skewed distribution;χ^(2) test was used to compare the counting data;Logistic regression was used to analyze the impact factors affecting prognosis.Results The incidence of cirrhosis in the death group was 88.14%(52/59),which was significantly higher than that of 18.75%(9/48)in the survival group(P<0.05).The levels of albumin,γ-transglutaminase and cholinesterase in the survival group were significantly higher than those in the death group.The total bilirubin,prothrombin time,international normalized ratio,and model for end-stage liver disease(MELD)score in the survival group were significantly lower than those in the death group(P<0.05).The grades of acute-on-chronic liver failure(ACLF)classification between these two groups were significantly different(P<0.05).Logistic regression was used to analyze the impact factors affecting prognosis.The result indicated that higher ACLF grades and liver cirrhosis are independent predictors of poor prognosis.Conclusion CHB patients with liver cirrhosis have a higher risk of liver failure after discontinuation of anti-viral drugs.The patients have a higher mortality rate once progress to liver failure.Meanwhile,the clinical outcome of the CHB patients with liver failure due to discontinuation of anti-viral drugs is associated with the severity grade of ACLF classification and whether the patient has cirrhosis.