乙肝相关性慢加急性肝衰竭发病诱因及临床预后分析

发布时间：2018-07-01 19:16

  本文选题：乙型肝炎病毒 + 慢加急性肝衰竭　； 参考：《宁夏医科大学》2017年硕士论文

【摘要】：目的探讨乙肝相关性慢加急性肝衰竭(HBV-ACLF)患者的发病诱因及临床因素对预后的影响。方法对宁夏医科大学总医院感染性疾病科2006年1月1日至2015年12月31收治的117例HBV-ACLF患者进行回顾性分析,并收集一般资料:包括性别、年龄、民族、发病诱因、并发症、是否抗病毒治疗以及实验室检查:总胆红素(TBIL)、尿素氮(BUN)、肌酐(SCr)、白细胞(WBC)、血小板(PLT)、血清Na+、K+、凝血酶原活动度(PTA)、甲胎蛋白(AFP)、乙肝病毒载量(HBV DNA)、乙肝表面抗原(HBs Ag)、e抗原(HBeAg)、腹部B超或CT等。结果(1)117例HBV-ACLF患者中男性101例,女性16例,汉族88例,回族29例,治疗好转50例,恶化/死亡67例。(2)HBV-ACLF发病的诱因中,自行停用或不规律服用抗病毒药物所致的HBV-ACLF增多。好转组和恶化/死亡组的诱因构成比无差异(p0.05)。(3)恶化/死亡组年龄高于好转组,且年龄≤50岁组好转率明显高于50岁组,差异有统计学意义(p0.05)。(4)好转组的甲胎蛋白(AFP)水平明显高于恶化/死亡组,差异有统计学意义(p0.05)。且AFP越高,预后越好。(5)肝硬化组和慢性肝炎组两者预后无统计学意义(p0.05)。(6)随临床分期进展,好转率逐渐下降,且各组间差异有统计学意义(p0.05)。(7)e抗原阳性与否和HBV DNA水平高低在好转组和恶化/死亡组之间差异无统计学意义(p0.05)。(8)抗病毒治疗组好转率明显高于未抗病毒治疗组,差异有统计学意义(p0.05)。(9)恶化/死亡组发生肝性脑病、肝肾综合征、电解质紊乱的概率显著高于好转组。且恶化/死亡组并发症的发生率,尤其是发生3种或3种以上的发生率明显高于治疗好转组差异具有统计学意义(p0.05)。(10)影响HBV-ACLF患者预后的因素进行Logistic回归分析发现,临床分期、年龄是影响疾病的预后的危险因素。临床分期中疾病早期人群治疗后好转率是晚期人群的13.323倍;年龄≤50岁的人群治疗后好转率是年龄50岁人群的4.41倍。结论(1)自行停用或不规律服用抗病毒药物诱发的乙肝相关性慢加急性肝衰竭患者增多;(2)慢加急性肝衰竭患者年龄越大,临床分期越晚,并发症越多,预后越差;(3)慢加急性肝衰竭患者甲胎蛋白水平越高、经过抗病毒治疗者,预后越好。
[Abstract]:Objective to investigate the predisposing factors and the influence of clinical factors on the prognosis of patients with chronic hepatitis B associated with acute liver failure (HBV-ACLF). Methods A retrospective analysis of 117 HBV-ACLF patients admitted to the Department of Infectious Diseases, General Hospital of Ningxia Medical University from January 1, 2006 to December 31, 2015 was carried out, and general data were collected, including sex, age, nationality, cause of onset, complications. Antiviral therapy and laboratory tests: total bilirubin (TBIL), urea nitrogen (bun), creatinine (SCR), white blood cell (WBC), platelet (PLT), serum Na, Prothrombin activity (PTA), alpha-fetoprotein (AFP), HBV DNA, hepatitis B surface antigen (HBs Ag), HBeAg, abdominal B ultrasound or CT, etc. Results (1) among 117 HBV-ACLF patients, 101 were male, 16 were female, 88 were Han nationality, 29 were Hui, 50 were better and 67 were worse / dead. (2) HBV-ACLF was increased due to withdrawal or irregular administration of antiviral drugs. There was no difference in the inducement composition ratio between the improvement group and the deterioration / death group (p0. 05). (3). The age of the deterioration / death group was higher than that of the improvement group, and the improvement rate of the age 鈮，

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