摘要
目的探讨老年乙型肝炎病毒（HBV）相关慢加急性肝衰竭（ACLF）患者的临床特点,以及影响患者近期预后的危险因素。方法对我院2010年1月~2014年1月收治的139例老年HBV相关ACLF患者进行回顾性研究,选取同时期199例非老年HBV相关ACLF患者进行对照。运用多因素Logistic回归分析,得出影响老年患者近期（12周）预后的危险因素。结果老年组在女性发生率、肝硬化发生率、食管静脉曲张破裂出血发生率、肝肾综合征（HRS）发生率、碱性磷酸酶（ALP）、血糖（GLU）等方面高于非老年组;老年组在生存率、白细胞数（WBC）、血小板（PLT）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、白蛋白（ALB）、胆碱脂酶（CHE）、钠（Na）等方面低于非老年组。根据近期预后将老年HBV相关ACLF患者分为生存组和死亡组,死亡组在有无乙肝家族史、肝硬化发生率、肝性脑病（HE）发生率、食管静脉曲张破裂出血发生率、HRS发生率、腹水发生率、感染发生率、国际标准化比率（INR）、总胆红素（TBIL）、胆汁酸（TBA）、肌酐（CRE）、乙肝抗原（HBe Ag）阳性率等方面高于生存组;死亡组在PLT、ALB、CHE、Na等方面低于生存组。多因素Logistic回归分析显示,乙肝家族史、HE、INR、TBIL、TBA、CRE、Na是预测老年HBV相关ACLF患者近期预后的独立危险因素。结论老年HBV相关ACLF患者肝脏基础差、并发症发生率高、女性发生率高,整体预后不良。乙肝家族史、HE、INR、TBIL、TBA、CRE、Na是预测老年HBV相关ACLF患者近期预后的独立危险因素。
Objective To explore clinical characteristics and short-term prognostic risk factors in the elderly hepatitis B virus（HBV） related acute-on-chronic liver failure（ACLF） patients. Methods 139 elderly patients of HBV-related ACLF were admitted to our hospital from January 2010 to January 2014 and they were accepted a retrospective study. As the same period,199 non-elderly patients of HBV-related ACLF were admitted to our hospital as control. Multivariate Logistic regression analysis was used for selecting the risk factors for short-term（12 weeks） prognosis of the elderly patients. Results In the older group,the incidence of women,the incidence of cirrhosis,the incidence of esophageal variceal bleeding,the incidence of hepatorenal syndrome（HRS）,the level of ALP and GLU were higher than the non-elderly group. In the older group,the survival rate,the level of WBC,PLT,ALT,AST,ALB,CHE and Na were lower than the non-elderly group. According to the short-term prognosis,the elderly HBV-related ACLF patients were divided into survival group and death group. In death group, the incidence of family history of Chronic Hepatitis B,liver cirrhosis,HE,esophageal variceal bleeding,HRS,ascites,infection,the level of INR,TBIL,TBA and CRE, HBe Ag-positive rate were higher than the survival group. In death group,the level of PLT,ALB,CHE and Na were lower than the survival group.Multivariate Logistic regression analysis showed that family history of Chronic Hepatitis B,HE,the level of INR,TBIL,TBA,CRE and Na were the independent risk factors to predict short-term prognosis of the elderly patients of HBV-related ACLF. Conclusion For the elderly patients of HBV-related ACLF patients,they have poor liver foundations,high incidence of complications and high incidence of women,so they have an overall poor prognosis. Family history of Chronic Hepatitis B,HE,the level of INR, TBIL,TBA,CRE and Na are the independent risk factors to predict short-term prognosis of the elderly patients of HBV-related ACLF.
出处
《中华保健医学杂志》
2015年第2期108-112,共5页
Chinese Journal of Health Care and Medicine
基金
"十二五"国家传染病科技重大专项(2012ZX10002004-005)
关键词
老年人
乙型肝炎病毒
慢加急性肝衰竭
近期预后
危险因素
The elderly
Hepatitis B virus
Acute-on-chronic liver failure
Short-term prognosis
Risk factor
