HBV相关慢加急性肝衰竭和失代偿期肝硬化患者急性肾损伤预后影响因素分析

Analysis on influencing factors for prognosis of acute kidney injury in patients with HBV-related acute-on-chronic acute liver failure and decompensated cirrhosis

目的评估HBV相关慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)和失代偿期肝硬化(decompensatory cirrhosis,DC)患者发生急性肾损伤(acute kidney injury,AKI)事件及预后的差异。方法选取2016年12月—2018年7月延安市人民医院收治的252例HBV相关ACLF(HBV-ACLF)患者和119例HBV相关DC(HBV-DC)患者作为研究对象,检测上述患者尿液中肾小管损伤生物标志物的水平,并比较分析患者预后情况。结果252例HBV-ACLF患者中发生AKI 63例(25.00%),119例HBV-DC患者中发生AKI 25例(21.01%),2组发病率相比较,差异无统计学意义(P>0.05)。与HBV-ACLF-非AKI组患者相比,HBV-ACLF-AKI组患者尿液中肾小管损伤生物标志物水平均显著升高,90 d生存率显著降低(P均<0.05);与HBV-DC-非AKI组患者相比,HBV-DC-AKI组患者90 d生存率也显著降低(P<0.05)。HBV-ACLF-AKI组患者平均中位生存时间为49.4 d,HBV-DC-AKI组患者平均中位生存时间为48.1 d。多因素分析结果显示,与HBV-DC-非AKI患者相比,HBV-ACLF-非AKI、HBV-DC-AKI、HBV-ACLF-AKI患者90 d死亡风险HR依次为3.442、5.249、7.294(P均<0.05)。此外,年龄增大、肝性脑病和腹水增加了患者90 d死亡风险(P均<0.05)。结论HBV-ACLF、HBV-DC患者AKI发病率无显著区别。HBV-ACLF、HBV-DC患者发生AKI后生存时间更短、死亡风险更高,其中HBV-ACLF患者发生AKI后预后最差。在临床救治中应对上述两种患者给予更多关注,以不同方式进行管理。

Objective To evaluate the differences of acute kidney injury(AKI)events and outcomes in patients with HBV-related acute-on-chronic liver failure(ACLF)and decompensated cirrhosis(DC).Methods Two hundred and fifty-two HBV-ACLF patients and 119 HBV-DC patients were selected from Yan’an People’s Hospital from December 2016 to July 2018.The levels of urinary biomarkers for renal tubular injury in the above-mentioned patients were detected,and the prognosis of the patients was compared and analyzed.Results AKI occurred in 63(25.00%)patients of 252 HBV-ACLF patients and in 25(21.01%)patients of 119 HBV-DC patients.The incidence between 2 groups showed no statistically significant difference(P>0.05).Compared with HBV-ACLF-non-AKI group,the levels of urinary biomarkers for renal tubular injury were significantly increased in the HBV-ACLF-AKI group.The 90-day survival rate was significantly decreased(P<0.005).Compared with the HBV-DC-non-AKI group,the 90-day survival rate in the HBV-DC-AKI group was also significantly decreased(P<0.05).The mean median survival time was 49.4 d in the HBV-ACLF-AKI group and 48.1 d in the HBV-DC-AKI group.The multivariate analysis results showed that compared with the HBV-DC-non-AKI patients,the 90-day mortality risk HR of HBV-ACLF-non-AKI patients,HBV-DC-AKI patients and HBV-ACLF-AKI patients were 3.442,5.249 and 7.294,respectively(P<0.05).In addition,older age,hepatic encephalopathy and ascites increased the risk of 90-day mortality(P<0.05).Conclusions The incidence of AKI in patients with HBV-ACLF or HBV-DC shows no significant differences.HBV-ACLF and HBV-DC patients have shorter survival time and higher risk of death after AKI.Patients with HBV-ACLF have the worst prognosis after AKI.In clinical treatment,more attention should be paid to these 2 kinds of patients and they should be managed in different ways.