乙型肝炎病毒相关慢加急性肝衰竭合并肝性脑病患者临床特点及预后影响因素分析

The clinical features and prognostic determinates of patients with hepatitis B related acute-on-chronic liver failure complicated with hepatic encephalopathy

目的探讨乙型肝炎病毒相关慢加急性肝衰竭合并肝性脑病患者的临床特点及其预后影响因素。方法回顾性分析2015年1月至2020年12月在广州医科大学附属市八医院住院的乙型肝炎病毒相关慢加急性肝衰竭合并肝性脑病患者234例,分析其临床特点,应用多因素logistic回归分析预后的影响因素。结果234例患者中,治疗好转104例,恶化/死亡130例。治疗好转组是否存在肝硬化、总胆红素、凝血酶原活动度、血清钠、是否合并腹膜炎分别为(71/33)例、(374.08±100.05)μmol/L、(29.63±5.70)%、(135.75±6.46)mmol/L、(49/55)例,恶化/死亡组分别为(104/26)例、(410.55±136.41)μmol/L、(23.82±10.87)%、(132.86±5.81)mmol/L、(78/52)例,差异有统计学意义(χ^(2)=4.217,t=-2.357,t=5.258,t=3.592,χ^(2)=3.865,均P<0.05)。好转组是否人工肝治疗44/60例、恶化/死亡组43/87例,差异无统计学意义(χ^(2)/P=2.108/0.147)。肝性脑病Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者住院期间病死率分别为0、3.41%、12.31%、65.91%,差异有统计学意义(χ^(2)/P=94.291/0.000)。肝硬化基础[OR(95%CI)=2.095(1.046~4.194),P=0.037]、总胆红素[OR(95%CI)=1.003(1.000~1.005),P=0.039]、血清钠[OR(95%CI)=0.911(0.867~0.958),P<0.01]、凝血酶原活动度[OR(95%CI)=0.921(0.888~0.955),P<0.01]是乙型肝炎病毒相关慢加急性肝衰竭合并肝性脑病患者预后的独立危险因素,血清钠高、凝血酶原活动度高是预后的保护因素。结论肝硬化基础、总胆红素、血清钠、凝血酶原活动度是乙型肝炎病毒相关慢加急性肝衰竭合并肝性脑病患者预后的独立危险因素,准确把握危险因素,积极干预,争取提高患者救治的成功率。

Objective To analysis the clinical characteristics and prognostic influencing factors of patients suffering from the hepatitis B-related acute-on-chronic liver failure complicated with hepatic encephalopathy.Methods Two hundred and thirty-four patients suffering from the hepatitis B virus related acute-on-chronic liver failure complicated with hepatic encephalopathy who were hospitalized in Guangzhou Eighth People’s Hospital,Guangzhou Medical University from January 2015 to December 2020 were enrolled in this study.They were divided into an improved group and a deteriorated/death group.The patients were retrospective analyzed with multiple logistic regression analysis for their clinical characteristics and prognostic influencing factors.Results There were statistically significant differences in the status of liver cirrhosis(with/without),the levels of total bilirubin,prothrombin time activity and serum sodium,the complication of peritonitis(with/without)between the patients of the improved group(71/33,374.08±100.05 umol/L,29.63±5.70%,135.75±6.46 mmol/L,and 49/55,respectively)and the deteriorated/death group(104/26,410.55±136.41 umol/L,23.82±10.87%,132.86±5.81 mmol/L,and 78/52,respectively)(χ^(2)/P=4.217/0.040,t/P=-2.357/0.019,t/P=5.258/0.000,t/P=3.592/0.000,χ^(2)/P=3.865/0.049,respectively).whereas there was no significant difference in the prognosis of patients with or without artificial liver treatment(44/60 in the improved group,and 43/87 in the deteriorated/death group)(χ^(2)/P=2.108/0.147).When compared the fatality rates of patients during hospitalization according to their phases of hepatic encephalopathy,there were significant differences among the patients with phasesⅠ,Ⅱ,ⅢandⅣencephalopathy(0,3.41%,12.31%,65.91%,respectively)(χ^(2)/P=94.291/0.000).With background of liver cirrhosis,significant abnormalities in the levels of total bilirubin,serum sodium and prothrombin time activity were independent risk factors for the prognosis of patients suffering from the hepatitis B related acute-on-chronic liver failure complicated with hepatic encephalopathy[OR(95%CI)=2.095(1.046-4.194),P=0.037;OR(95%CI)=1.003(1.000-1.005),P=0.039;OR(95%CI)=0.911(0.867-0.958),P=0.000;OR(95%CI)=0.921(0.888-0.955),P=0.000;respectively],and high serum sodium and high prothrombin time activity are the prognostic protective factors.Conclusion With liver cirrhosis background,significant abnormalities in total bilirubin,serum sodium and prothrombin time activity are the independent risk factors for the prognosis of patients suffering from the hepatitis B-related acute-on-chronic liver failure complicated with hepatic encephalopathy.Therefore,active interventions shoud be provided timely to patients with risk factors of poor prognosis for improving the successful rate of treatments.