摘要
目的回顾重症酒精性肝炎(SAH)患者临床资料,比较非SAH-慢加急性肝衰竭(ACLF)、SAH-ACLF患者临床特征、预后评分及短期预后,为SAH病情管理、预后评价及治疗策略制定提供依据。方法收集2009年1月至2021年10月SAH患者112例(男105例,女7例),年龄(49.6±9.4)岁。根据SAH患者是否存在慢加急性肝衰竭(ACLF)分为非SAH-ACLF、SAH-ACLF。比较非SAH-ACLF、SAH-ACLF患者临床特征、预后评分及28天、90天生存率。对偏态分布的计量资料以[M(P_(25),P_(75))]表示,采用Mann-Whitney U检验;对正态分布的计量资料以(±s)表示,采用独立t检验;计数资料以绝对数表示,采用卡方检验比较;生存率比较采用Log-Rank检验。结果非SAH-ACLF、SAH-ACLF患者分别为82例、30例。比较临床特征可知,非SAH-ACLF患者消化道出血、肝性脑病、感染及腹水为9例(11.0%)、8例(9.7%)、19例(23.2%)及27例(32.9%),与SAH-ACLF[8例(26.7%)、16例(53.3%)、17例(56.7%)及20例(66.7%)]比,差异具有统计学意义(χ^(2)=-4.200,-24.733,-11.299,-10.267,P<0.05);非SAH-ACLF患者白细胞(WBC)、总胆红素(TBil)、直接胆红素(DBil)、尿素氮(BUN)及肌酐(Scr)为7.0(4.6,10.8)×10^(9)/L、140.6(98.4,302.8)μmol/L、82.0(44.4,172.5)μmol/L、4.8(3.1,6.5)mmol/L及58.4(52.0,76.5)μmol/L,与SAH-ACLF[9.4(6.5,14.5)×10^(9)/L、242.8(186.0,412.6)μmol/L、162.5(90.2,231.8)μmol/L、9.2(4.0,15.4)mmol/L及91.4(65.4,220.6)μmol/L]比,差异具有统计学意义(Z=-3.914,-10.126,-11.020,-10.104,-8.002,P<0.05);非SAH-ACLF患者凝血酶原时间(PT)、国际标准化比值(INR)为20.2(19.0,23.6)s、1.6(1.5,2.0),与SAH-ACLF[26.5(21.5,32.2)s、2.2(1.8,2.8)]比,差异具有统计学意义(Z=-3.802,-3.914,P<0.05)。非SAH-ACLF患者MDF评分、MELD评分、ABIC评分、CLIF-SOFA评分、CLIF-C OFs及CLIF-C ACLF评分为52.0(41.5,68.4)分、11.2(9.0,14.2)分、7.4(6.0,9.0)分、4.0(3.0,5.0)分、8.0(7.0,9.0)分及35.4(30.2,42.5)分,与SAH-ACLF[82.0(56.2,108.0)分、20.8(15.5,25.4)分、8.8(7.5,10.6)分、6.0(5.0,8.0)分、10.0(9.0,11.0)分及48.0(40.0,52.1)分]比,差异具有统计学意义(Z=2.664,6.508,2.251,2.610,2.412,5.268,P<0.05)。非SAH-ACLF、SAH-ACLF患者28天生存率为95.1%(78/82)、70.0%(21/30),差异具有统计学意义(χ^(2)=11.511,P<0.05);非SAH-ACLF、SAH-ACLF患者90天生存率为84.1%(69/82)、46.7%(14/30),差异具有统计学意义(χ^(2)=16.079,P<0.05)。结论与未并发ACLF的SAH患者相比较,并发ACLF后无论是并发症、血生化指标,还是各项预后评分均显著差于前者,同时短期预后也明显不理想,需要在临床实践中着重关注。
Objective To review the clinical data of severe alcoholic hepatitis(SAH)patients,and compare the clinical features,prognosis scores and short-term prognosis of non-SAH-acute-on-chronic liver failure(ACLF)and SAH-ACLF patients,so as to provide basis for SAH disease management,prognosis evaluation and treatment strategy formulation.Methods From January 2009 to October 2021,112 patients with SAH[105 males and 7 females,aged(49.6±9.4)years]were collected.Patients with SAH were divided into non-SAH-ACLF group and SAH-ACLF group according to whether there was ACLF.We compared the clinical features,prognosis scores and 28-day and 90-day survival rates between patients in two groups.The measurement data of skewness distribution was expressed as[M(P_(25),P_(75))],and Mann-Whitney U test was adopted.The measurement data of normal distribution was expressed as(±s),and independent t test was adopted.Counting data were expressed as absolute numbers,which were compared by Chi-square test.The survival rate was compared by Log-Rank test.Results There were 82 and 30 patients without SAH-ACLF and with SAH-ACLF,respectively.According to the clinical characteristics,9 cases(11.0%),8 cases(9.7%),19 cases(23.2%)and 27 cases(32.9%)of gastrointestinal bleeding,hepatic encephalopathy,infection and ascites in non-SAH-ACLF group,which were compared with SAH-ACLF group[8 cases(26.7%),16 cases(53.3%),17 cases(56.7%)and 20 cases(66.7%)],with statistical significance(χ^(2)=-4.200,-24.733,-11.299,-10.267,P<0.05).White blood cells(WBC),total bilirubin(TBil),direct bilirubin(DBil),urea nitrogen(BUN)and creatinine(Scr)in patients without SAH-ACLF were 7.0(4.6,10.8)×109/L,140.6(98.4,302.8)μmol/L,82.0(44.4,172.5)μmol/L,4.8(3.1,6.5)mmol/L and 58.4(52.0,76.5)μmol/L,compared with those in SAH-ACLF group[9.4(6.5,14.5)×109/L,242.8(186.0,412.6)μmol/L,162.5(92.5,231.8)μmol/L,9.2(4.0,15.4)mmol/L and 91.4(65.4,220.6)μmol/L,with statistical significance(Z=-3.914,-10.126,-11.020,-10.104,-8.002,P<0.05).The prothrombin time(PT)and international normalized ratio(INR)of non-SAH-ACLF group were 20.2(19.0,23.6)s and 1.6(1.5,2.0),which were significantly higher than those of SAH-ACLF group[26.5(21.5,32.2)s and 2.2(1.8,2.0),Z=-3.802,-3.914,P<0.05].The Maddrey discriminant function(MDF)score,model for end-stage liver disease(MELD)score,Age-bilirubin-INR-creatinine(ABIC)score,chronic liver failure-sequential organ failure(CLIF-SOFA)score,chronic liver failure-Consortium Organ Failure score(CLIF-C OFs)and CLIF-C ACLF score of non-SAH-ACLF patients were 52.0(41.5,68.4)points,11.2(9.0,14.2)points,7.4(6.0,9.0)points,(7.4.9.0)points,4.0(3.0,5.0)points,8.0(7.0,9.0)points and 35.4(30.2,42.5)points,compared with those in SAH-ACLF group[82.0(56.2,108.0)points,20.8(15.5,25.4)points,8.8(7.5,10.6)points,6.0(5.0,8.0)points,10.0(9.0,11.0)points and 48.0(40.0,52.1)points],with statistical significance(Z=2.664,6.508,2.251,2.610,2.412,5.268,P<0.05).The 28-day survival rates of non-SAH-ACLF and SAH-ACLF patients were 95.1%(78/82)and 70.0%(21/30),with statistical significance(χ^(2)=11.511,P<0.05).The 90-day survival rates of non-SAH-ACLF and SAH-ACLF patients were 84.1%(69/82)and 46.7%(14/30),with statistical significance(χ^(2)=16.079,P<0.05).Conclusion Compared with SAH patients without ACLF,complications,blood biochemical indexes and prognosis scores after ACLF are significantly worse than the former,and the short-term prognosis is obviously unsatisfactory,which needs to be paid attention to in clinical practice.
作者
李向阳
唐泉淼
王雷
LI Xiang-yang;TANG Quan-miao;WANG Lei(Affiliated Hospital of Henan Medical College Department of Gastroenterology,Xinzheng 451191,China;Affiliated Hospital of Henan Medical College Department of Surgery,Xinzheng 451191,China)
出处
《肝脏》
2022年第5期584-587,共4页
Chinese Hepatology
基金
河南省医学科技攻关计划联合共建项目(2018020853)。
