南方医科大学学报

南方医科大学学报 ›› 2018, Vol. 38 ›› Issue (06): 736-.

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乙型肝炎相关慢加急性肝衰竭患者的长期预后及生存质量

诸聪妍，卢观婷，祁婷婷，何钦俊，陈永鹏，文维群，周福元，陈金军   

  • 出版日期:2018-06-20 发布日期:2018-06-20

Long-term prognosis and quality of life of survivors with hepatitis B virus-related acuteon- chronic liver failure

  • Online:2018-06-20 Published:2018-06-20

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摘要： 目的探讨乙型肝炎相关慢加急性肝衰竭（HBV-ACLF）存活者长期预后及健康相关的生存质量。方法选取2011年11月 ~2016年10月在南方医科大学南方医院收治的存活时间超过90 d的HBV-ACLF患者，回顾性分析其临床资料，进行随访，记录 肝硬化发展、肝硬化失代偿、肝癌发生及死亡等不良事件的发生；并选择同期门诊就诊的慢性乙型肝炎、乙肝肝硬化患者作为对 照组，应用SF-36量表对ACLF存活者与常模及对照组的生活质量评分进行比较。结果共入组ACLF患者223例，根据入院时 是否合并肝硬化分为乙型肝炎组(CHB-ACLF，n=130）和乙肝肝硬化组（CIR-ACLF，n=93）。CHB-ACLF组12个月、24个月、50 个月的累计生存率为97%、95.7%和93.9%，高于CIR-ACLF组的91%、86%和74%（P=0.007）。CHB-ACLF存活者12个月、24个 月、36个月的肝硬化进展率分别是37.9%、58.4%和68.7%。Cox回归结果发现，患者入院时钠水平（HR=0.84，P=0.035）、发病 28 d内肌酐最高值（HR=1.015，P=0.026）及INR最高值（HR=2.032，P=0.006）是影响肝硬化发生的独立危险因素。ACLF恢复者 SF-36量表的心理健康评分低于常模，其他维度与常模相比无统计学差异；与慢性乙型肝炎、乙肝肝硬化患者相比，ACLF患者 在一般健康和躯体疼痛维度得分更高，其余维度差异无统计学意义。结论乙型肝炎疾病基础不同可导致ACLF患者长期预后 有所差别。严重的急性打击事件可增加CHB-ACLF患者肝硬化的发生率，可能与肝衰竭时各器官的损害程度有关。ACLF长 期存活患者生活、社会能力无显著降低，但心理状态受到一定影响。

Abstract: Objective To explore the long-term prognosis and health-related quality of life of patients surviving hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods The clinical data were collected from patients with HBV-ACLF, who were hospitalized in our department between November, 2011 and October, 2016 and survived for more than 90 days. The patients were followed for occurrence of newly diagnosed cirrhosis, decompensation events, hepatocellular carcinoma and death. The quality of life of the patients was evaluated using SF-36 score, and the patients with chronic hepatitis B (CHB) and cirrhosis treated during the same period served as controls. Results A total of 223 ACLF survivors were included in this study. According to the presence of cirrhosis on admission, the enrolled patients were divided into chronic hepatitis Brelated ACLF (CHB-ACLF) group (n=130) and liver cirrhosis ACLF (CIR-ACLF) group (n=93). The 12-, 24- and 50-month survival rates in CHB-ACLF group were 97%, 95.7% and 93.9%, respectively, significantly higher than the rates in CIR-ACLF group (91%, 86% and 74%, respectively; P=0.007). In patients with CHB-ACLF, the 12-, 24- and 36-month progression rates of cirrhosis were 37.9%, 58.4% and 68.7% respectively. Multivariate Cox regression identified the peak value of serum creatinine (HR=1.015, P=0.026) and INR (HR=2.032, P=0.006) within 28 days as independent risk factors and serum sodium at baseline (HR=0.84, P=0.035) as an independent protective factor of occurrence of cirrhosis. The score of mental health on SF-36 in ACLF group was significantly lower than the national norms, and the scores for general health and body pain of ACLF patients were significantly higher than those in patients with CHB or cirrhosis. Conclusion The long-term prognosis of ACLF survivors with and without cirrhosis can be different. Acute attacks are associated with an increased rate of cirrhosis progression in CHB patients who recovered from ACLF, possibly in relation with the severity of extra-hepatic organ injuries. The physical and social functions of long-term survivors of ACLF do not significantly decline, but their psychological status can be affected.