论文部分内容阅读
目的观察人工肝支持系统(ALSS)治疗的乙型肝炎病毒(HBV)相关慢加急性肝功能衰竭(ACLF)患者的转归,研究影响其预后的相关因素。方法 2011年1月-2014年6月收治HBV-ACLF患者321例,收集患者入院后基线及ALSS治疗前后的临床资料,进行单因素分析及多因素回归分析,筛选出影响患者30 d预后的独立危险因素。结果 321例患者在30 d观察终点时,存活233例,死亡88例。单因素分析结果显示:死亡组合并肝硬化基础及肝肾综合征、肝性脑病、腹膜炎的发生率较存活组高,差异有统计学意义(P<0.05);死亡组的终末期肝病评分模型分值、白细胞计数、血氨、肌酐、各阶段的总胆红素水平高于存活组,差异有统计学意义(P<0.05);死亡组的基础HBV-DNA载量、3次ALSS治疗后总胆红素下降水平、基线凝血酶原活动度及3次ALSS治疗后凝血酶原活动度低于存活组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示白细胞计数(OR=2.337,P<0.001)、3次ALSS治疗后的总胆红素水平(OR=4.935,P<0.001)是预测经ALSS治疗的HBV-ACLF患者30 d死亡的独立危险因素,HBV-DNA(OR=0.403,P<0.001)、3次ALSS治疗后总胆红素下降水平(OR=0.447,P<0.001)及3次ALSS治疗后凝血酶原活动度水平(OR=0.332,P<0.001)是30 d预后的保护因素。结论白细胞计数、HBV-DNA载量、3次ALSS治疗后总胆红素及凝血酶原活动度水平、3次ALSS治疗后总胆红素下降水平是影响ALSS治疗HBV-ACLF患者短期预后的5个主要因素,在临床实践中,将其作为判断预后的指标对临床决策的制定有一定的指导价值。
Objective To investigate the prognosis of hepatitis B virus (HBV) -related chronic and acute liver failure (ACLF) patients treated with artificial liver support system (ALSS). Methods 321 patients with HBV-ACLF were enrolled from January 2011 to June 2014. The clinical data of baseline and ALSS before and after treatment were collected and analyzed by univariate analysis and multivariate regression analysis. The prognosis of patients with 30 d was screened out independently Risk factors. Results 321 patients survived 233 cases and died of 88 cases at the end of 30 days. The results of univariate analysis showed that the incidence of liver cirrhosis, hepatorenal syndrome, hepatic encephalopathy and peritonitis in death group was higher than that in survival group (P <0.05). The final liver disease score model Total serum bilirubin, serum creatinine, total bilirubin levels in each stage were higher than those in survivor group (P <0.05), basal HBV-DNA load in death group, The level of total bilirubin, baseline prothrombin activity and prothrombin activity after 3 ALSS treatments were lower than those in survivors (P <0.05). Multivariate logistic regression analysis showed that white blood cell count (OR = 2.337, P <0.001) and total bilirubin levels (OR = 4.935, P <0.001) (OR = 0.403, P <0.001), the level of total bilirubin (OR = 0.447, P <0.001) and the activity of prothrombin The level (OR = 0.332, P <0.001) was a protective factor for the 30-day prognosis. CONCLUSIONS: The levels of total bilirubin and prothrombin in white blood cell count, HBV-DNA load, three ALSS treatments and the level of total bilirubin after three ALSS treatments are the short-term prognostic factors of ALSS in patients with HBV-ACLF.5 A major factor in clinical practice, as a prognostic indicator as a clinical decision-making has some guiding value.