2012至2021年北京佑安医院肝衰竭住院患者流行病学特征

Epidemiological characteristics of inpatients with liver failure at the Beijing You'an Hospital from 2012 to 2021

目的阐述肝衰竭流行病学特征及其变化趋势,以期为肝衰竭防治策略提供循证依据。方法回顾性收集北京佑安医院2012年至2021年收治的肝衰竭住院患者流行病学信息,应用趋势检验分析其年龄、性别,以及急性肝衰竭(ALF)、亚急性肝衰竭(SALF)的急性病因和慢加急性肝衰竭(ACLF)、慢性肝衰竭(CLF)的慢性肝病基础病因的逐年变化。结果在研究期间,共收集8512例肝衰竭住院患者信息,年龄为(51.3±13.5)岁,男性患者为主(71.9%),肝衰竭类型的比例从高到低依次为ACLF 4023例(47.3%)、CLF 3571例(42.0%)、SALF 670例(7.9%)、ALF 248例(2.9%)。肝衰竭整体人群中前5位的病因依次是乙型肝炎3199例(37.6%)、酒精性肝病2237例(26.3%)、隐源性肝病906例(10.6%)、乙型肝炎+酒精性肝病603例(7.1%)、药物488例(5.7%),共占比87.6%。不同类型肝衰竭患者的前3位病因分别是:ALF的急性病因,依次为药物107例(43.1%)、乙型肝炎47例(19.0%)、不明原因36例(14.5%),SALF的急性病因依次为药物381例(56.9%)、不明原因106例(15.8%)、脓毒症56例(8.4%);ACLF的慢性病因依次为乙型肝炎2092例(52.0%)、酒精性肝病813例(20.2%)、隐源性肝病398例(9.9%);而CLF的慢性病因依次是酒精性肝病1410例(39.5%)、乙型肝炎1028例(28.8%)、隐源性肝病364例(10.2%)。纵向分析显示肝衰竭患者的平均年龄逐年增加,性别比例未见显著变化趋势,始终以男性患者为主;在ALF、SALF患者中药物性肝衰竭比例逐年升高,趋势检验差异有统计学意义(P<0.05)。在ACLF、CLF患者的慢性病因中,乙型肝炎比例逐年下降,而酒精性肝病、自身免疫性肝病、隐源性肝病的比例逐年增加(P<0.05)。结论我国肝衰竭病因谱正在发生改变,尽管乙型肝炎仍然是肝衰竭的主要病因,但其占比呈现逐年减少趋势,除ACLF外,已不再是其他类型肝衰竭的首要病因,而药物性肝病、酒精性肝病、自身免疫性肝病、隐源性肝病呈逐年增加,将成为未来肝病防治的重点。

Objective To elucidate the epidemiological characteristics and changing trends of liver failure in order to provide evidence-based strategies for prevention and treatment.Methods The epidemiological information of inpatients with liver failure admitted and treated at Beijing You'an Hospital from 2012 to 2021 was retrospectively collected.The trend test was used to analyze age,gender,as well as the year-by-year changes in the underlying acute and chronic etiology of acute liver failure(ALF),sub-acute liver failure(SALF),acute-on-chronic liver failure(ACLF),and chronic liver failure(CLF).Results During the study period,information on a total of 8512 inpatients,aged 51.3±13.5 years and mainly male(71.9%)with liver failure,was collected.The highest to lowest proportions of liver failure types were ACLF 4023(47.3%),CLF 3571(42.0%),SALF 670(7.9%),and ALF 248(2.9%).The top five causes of liver failure in the overall population,accounting for 87.6%of the total,were hepatitis B 3199(37.58%),alcoholic liver disease 2237(26.28%),cryptogenic liver disease 906(10.61%),hepatitis B+alcoholic liver disease 603(7.08%),drugs 488(5.73%),The top three etiologies of patients with different types of liver failure were acute etiologies for acute liver failure(ALF),followed by drugs 107(43.1%),hepatitis B 47(19.0%),and unknown etiology 36(14.5%);sub-acute liver failure(SALF),followed by drugs 381(56.9%),unknown etiology 106(15.8%),and sepsis 56(8.4%);and acute-on-chronic liver failure(ACLF),followed by drugs 2092(52.0%),alcoholic liver disease 813(20.2%),and cryptogenic liver disease 398(9.9%);and chronic etiologies for chronic liver failure(CLF),followed by alcoholic liver disease 1410(39.5%),hepatitis B 1028(28.8%),and cryptogenic liver disease 364(10.2%).Longitudinal analysis showed that the average age of patients with liver failure increased year by year,but the sex ratio trend did not change significantly,with male patients predominating throughout.The proportion of drug-induced liver failure in patients with ALF and SALF increased year by year,and the difference in the trend test was statistically significant(P<0.05).The proportion of patients with chronic etiologies of ACLF and CLF decreased year by year among hepatitis B,while the proportion of alcoholic liver disease,autoimmune liver disease,and cryptogenic liver disease increased year by year(the difference was statistically significant,P<0.05).Conclusion The etiological spectrum of liver failure is changing in our country.Although hepatitis B is still the main cause of liver failure,its proportion shows a decreasing trend year by year,with the exception of ACLF,which is no longer the primary etiology of other types of liver failure,while drug-induced liver disease,alcoholic liver disease,autoimmune liver disease,and cryptogenic liver disease are increasing year by year and will become the focus of liver disease prevention and treatment in the future.