再代偿乙型肝炎肝硬化患者发生慢加急性肝衰竭的临床特点及预后分析

Clinical characteristics and prognosis of acute on chronic liver failure in patients with recompensatory hepatitis B cirrhosis

目的探讨再代偿乙型肝炎肝硬化患者发生慢加急性肝衰竭的临床特点和预后情况。方法选取2013年9月—2021年9月于天津市第三中心医院住院治疗的慢加急性肝衰竭患者180例,其中乙型肝炎肝硬化再代偿患者110例,同期的代偿期乙型肝炎肝硬化患者70例作为对照组,比较其诱因、临床生化指标、并发症发生率和预后。两组间分类变量比较应用χ^(2)检验或Fisher精确检验,对于连续性变量应用Mann-Whitney U检验。生存分析使用Kaplan-Meier方法,两组间比较采用Log-rank进行检验。结果再代偿组患者的肝肾综合征发生率(χ^(2)=4.618,P=0.032)、感染发生率(χ^(2)=6.712,P=0.010)、肌酐(Z=-4.508,P<0.001)、降钙素原(Z=-2.052,P=0.040)明显高于对照组。GGT(Z=-2.042,P=0.041)、Na(Z=-2.001,P=0.045)、空腹血糖(Z=-3.065,P=0.002)、TC(Z=-4.268,P<0.001)明显低于对照组。两组间90 d病死率(χ^(2)=3.366,P=0.067)和1年病死率(χ^(2)=1.893,P=0.169)比较差异均无统计学意义,经Log-rank检验,两组间90 d生存时间(χ^(2)=2.680,P=0.100)和1年生存时间(χ^(2)=2.074,P=0.150)比较差异均无统计学意义。结论与代偿期乙型肝炎肝硬化相比,再代偿后肝硬化患者发生慢加急性肝衰竭后肝肾综合征、感染及肌酐升高的发生风险增加,但90 d及1年的预后无明显差异。

Objective To assess the clinical characteristics of acute-on-chronic liver failure in patients with recompensatory hepatitis B cirrhosis.Methods A total of 180 patients with acute-on-chronic liver failure hospitalized in Tianjin Third Central Hospital from September 2013 to September 2021 were retrospectively collected,with 110 patients had compensatory hepatitis B cirrhosis and 70 patients had compensatory hepatitis B cirrhosis and used as the control.Their causes,clinical biochemical indicators,complication rate,and prognosis were compared.The Chi-square test or Fisher’s exact test was used for comparison of categorical variables between groups,and the Mann-Whitney U test was performed for analysis of the continuous variables.Kaplan-Meier curves and Log-rank test were used for survival of patients.Results The incidence of hepatorenal syndrome(χ^(2)=4.618,P=0.032),infection(χ^(2)=6.712,P=0.010),Cr(Z=-4.508,P<0.001),and PCT(Z=-2.052,P=0.040)were all higher,whereas GGT(Z=-2.042,P=0.041),Na(Z=-2.001,P=0.045),FBS(Z=-3.065,P=0.002),and TC(Z=-4.268,P<0.001)were all lower in the recompensation group than in the control group of patients.However,90-day mortality rate(χ^(2)=3.366,P=0.067)and 1-year mortality rate(χ^(2)=1.893,P=0.169),90-day survival(χ^(2)=2.68,P=0.100),and 1-year survival(χ^(2)=2.074,P=0.150)were not statistically significant difference.Conclusion Compared with compensatory hepatitis B cirrhosis,patients with recompensatory cirrhosis had an increased risk in developing hepatorenal syndrome,infection,and increased creatinine level after acute-on-chronic liver failure,although there was no statistically significant difference in 90-days and 1-year survival of patients.