[1]张明霞,覃国琦,李峰,等.脾脏肿大慢加急性肝衰竭病人的临床特点[J].南方医科大学学报,2014,(09):1310.
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脾脏肿大慢加急性肝衰竭病人的临床特点()
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《南方医科大学学报》[ISSN:/CN:]

卷:
期数:
2014年09期
页码:
1310
栏目:
出版日期:
2014-09-15

文章信息/Info

Title:
Clinical characteristics of patients with acute-on-chronic liver failure and splenomegaly
作者:
张明霞覃国琦李峰张琪何钦俊何雅静罗文凡王程陈金军
关键词:
慢加急性肝衰竭乙型肝炎病毒脾脏肿大
Keywords:
acute on chronic liver failure hepatitis B virus splenomegaly short term survival
摘要:
目的了解脾脏肿大慢性肝病患者发展为慢加急性肝衰竭后的临床特点和短期预后。方法回顾性收集慢性乙型肝炎病
毒感染相关的慢加急性肝衰竭病例,描述和分析脾脏肿大病人的临床特点。结果共纳入149例病人,4周死亡率48.3%。与无
脾脏肿大者相比,脾脏肿大的病人外周血小板计数(G/L)降低(78 vs 113,P=0.001),丙氨酸氨基转移酶(ULN)水平低(1.98 vs
4.73,P=0.005),凝血酶原时间国际标准化率低(2.03 vs 2.33,P=0.010),肝性脑病总体发生率接近(39.8% vs 38.8%,P=1.000),但
脾脏肿大者多为1~2级肝性脑病(P<0.001)。脾脏肿大者4周死亡率低(P=0.034),但90 d死亡率接近。脾脏肿大是4周死亡的
独立保护因素(RR=1.939,P=0.038),其他与4周死亡独立相关的因素包括中性粒细胞比例大于70%(RR=1.791,P=0.049)、肝性
脑病(RR=1.806,P=0.001)、血清肌酐水平(RR=1.457,P=0.004)及凝血酶原时间国际标准化率(RR=1.205,P=0.018)。新模型的
预测价值优于终末期肝病模型(曲线下面积0.860 vs 0.792,P=0.017)。结论脾脏肿大的慢加急性肝衰竭病人具有相对独特的
临床特征。
Abstract:
Objective To observe the clinical characteristics and short-term survival of patients with splenomegaly and
acute-on-chronic liver failure related to chronic HBV infection. Methods Electronic medical records of patients with
acute-on-chronic liver failure were collected to analyze the clinical parameters and 4-week survival of patients with or without
splenomegaly. Results Of the 149 patients enrolled, the overall 28-day mortality rate was 48.3%, which was lower in patients
with enlarged spleen than those without (34.2% vs 54.1%, P=0.034). Compared with patients without splenomegaly, patients
with splenomegaly had lower platelet counts (P=0.001), lower ALT levels (P=0.005) and lower PT-INR (P=0.010). Although the
occurrence of hepatic encephalopathy was comparable between patients with or without splenomegaly, severe conditions were
more frequent in those without splenomegaly. Hepatic encephalopathy grades, serum creatinine levels, neutrophil percentages
over 70%, PT-INR and splenomegaly were independent factors associated with the 28-day survival, and this novel model was
superior to model of end-stage of liver disease in predicting the 4-week survival (P=0.017). Conclusion Patients with
splenomegaly that evolves into acute-on-chronic liver failure have unique clinical characteristics and further clinical
observations are warranted.

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更新日期/Last Update: 1900-01-01