韦美华;祖亚洁;
WEI Meihua;ZU Yajie;Department of Gastroenterology,263 Clinical Department of Army General Hospital PLA;

• 1:陆军总院二六三临床部消化内科

摘要(Abstract)：

目的:分析乙型肝炎病毒(HBV)合并酒精性肝病(ALD)患者失代偿期肝硬化并发肝衰竭的相关危险因素。方法:收集HBV合并ALD的失代偿期肝硬化患者78例,将31例并发肝衰竭患者作为观察组,其余47例作为对照组;观察两组患者的肝功能Child-Pugh分级、腹水分级、食管胃底静脉曲张程度、并发食管胃底静脉曲张破裂出血、肝性脑病、肝肾综合征及细菌感染发生率,记录两组患者的饮酒年限、饮酒量血总胆红素(TBil),检测血谷丙转氨酶(ALT)、血氨、白蛋白(ALB)、肌酐、血钠、HBV-DNA定量及凝血酶原活动度(PTA),评估2组患者并发肝衰竭的相关危险因素、并进行Logistic回归分析。结果:观察组患者肝功能Child-Pugh分级、腹水分级、食管胃底静脉曲张程度、并发食管胃底静脉曲张破裂出血、肝性脑病、肝肾综合征、细菌感染发生率均高于对照组,差异有统计学意义(P <0. 05);观察组患者饮酒时间、饮酒量、血TBil、血氨、肌酐、血钠、HBV-DNA高于对照组,观察组患者血钠和PTA低于对照组,差异有统计学意义(P <0. 05)。结论:肝功能Child-Pugh分级、腹水、食管胃底静脉曲张、并发食管胃底静脉曲张破裂出血、肝性脑病、肝肾综合征、细菌感染发生率及患者及饮酒时间、饮酒量等是HBV合并ALD患者失代偿期肝硬化并发肝衰竭的相关危险因素。
Objective: To analyze the risk factors of liver failure of decompensated cirrhotic patients with hepatitis B virus infection( HBV) complicated with alcoholic liver disease( ALD),so as to provide the basis for early clinical prevention and treatment. Methods: 78 decompensated cirrhosis patients with HBV infection complicated with ALD were selected in our hospital from March 2016 to October 2017,of which 31 cases complicated by liver failure were chosen as the study group,and the remaining 47 cases as the control group. The related risk factors associated with liver failure of the patients were detected by Logistic regression analysis. Results: The incidence of child-pugh class( Grade C),ascites( Grade 3),esophageal varices( severe),gastroesophageal varices bleeding,hepatic encephalopathy,hepatorenal syndrome and bacterial infection of the study group were higher than those in the control group. The difference was statistically significant( P < 0. 05). The duration of drinking,alcohol consumption,serum Tbil,ammonia,creatinine,and serum Na +,HBV-DNA quantification of the study group were higher than those in the control group respectively,while serum sodium and PTA of the study group were lower than those of the control group,and the difference was statistically significant( P < 0. 05). Conclusion: The risk factors associated with liver failure in decompensated cirrhotic patients with HBV and ALD were correlated with child-pugh class( Grade C),ascites( Grade 3),esophageal varices( severe),gastroesophageal varices bleeding,hepatic encephalopathy,hepatorenal syndrome and bacterial infection,the duration of drinking,alcohol consumption,serum Tbil,ammonia,creatinine,serum Na +,HBV-DNA quantification and PTA.

关键词(KeyWords)： 肝炎病毒,乙型;肝炎,酒精性;肝硬化;肝功能衰竭;危险因素;回归分析
hepatitis B virus;hepatitis,alcoholic;liver cirrhosis;liver failure;risk factors;regression analysis

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金青年科学基金项目(81071356)

作者(Author): 韦美华;祖亚洁;
WEI Meihua;ZU Yajie;Department of Gastroenterology,263 Clinical Department of Army General Hospital PLA;

Email:

DOI: 10.19367/j.cnki.1000-2707.2018.09.021

参考文献(References)：

• [1]KIM T Y,LEE J G,SOHN J H,et al. Hepatic venous pressure gradient predicts long-term mortality in patients with decompensated cirrhosis[J]. Yonsei medical journal,2016,57(1):138-145.
• [2]张庆,李玲,丁红,等.超声造影联合血清学指标评估失代偿期肝硬化患者门静脉高压的临床价值[J].复旦学报:医学版,2017,44(4):467-471.
• [3]中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年版)[J].中华肝脏病杂志,2015,23(12):888-905.
• [4]中华医学会肝病学分会脂肪肝和酒精性肝病学组.酒精性肝病诊疗指南(2010年版)[J].中华肝脏病杂志,2010,18(3):167-170.
• [5]中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊疗指南[J].中华临床感染病杂志,2012,5(6):321-327.
• [6]中华医学会肝病学分会.肝硬化腹水及相关并发症的诊疗指南[J].临床肝胆病杂志,2017,33(10):1847-1863.
• [7]凡小丽,文茂瑶,沈怡,等.不同评分系统对失代偿期肝硬化患者短期和中期死亡风险预测能力的比较[J].临床肝胆病杂志,2017,33(7):1284-1290.
• [8]高潇雪,刘立新.酒精性肝病流行病学及发病机制研究进展[J].中华消化病与影像杂志:电子版,2016,6(2):62-65.
• [9]THOMSON M,VOLK M,KIM H M,et al. An automated telephone monitoring system to identify patients with cirrhosis at risk of re-hospitalization[J]. Digestive diseases and sciences,2015,60(12):3563-3569.
• [10]MARCHAN L A,DOMINGUEZ D L,KESSLER S P,et al. Liver failure in human immunodeficiency virus-Hepatitis C virus coinfection treated with sofosbuvir,ledipasvir and antiretroviral therapy[J]. Journal of hepatology,2016,64(3):752-753.
• [11]周静,苏菲.失代偿期肝硬化患者肝损伤急性加重100例临床分析[J].实用肝脏病杂志,2016,19(3):314-317.
• [12]揭方荣,郑嵘炅,邓泽润,等.肝硬化失代偿期患者食管胃底静脉曲张破裂再出血的危险因素分析[J].肝脏,2017,22(8):729-732.
• [13]王嗣予,黄辉煌,徐若男,等.肝病患者死亡原因分析:1 890例报告[J].解放军医学杂志,2014,39(5):392-395.

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