CAJ | 학술논문

目的：探讨人工肝治疗下乙型肝炎相关慢加急性肝功能衰竭的近期预后及其与HBeAg等各项临床检验指标之间的关系。为及时、准确判定乙型肝炎相关慢加急性肝功能衰竭预后提供参考。方法回顾性分析81例经体外人工肝支持及内科综合治疗乙型肝炎相关慢加急性肝功能衰竭患者（其中HBeAg阴性者55例，HBeAg阳性者26例）临床资料，分析不同HBeAg状态患者预后及各项检验指标（ALT、AST、TBil、白蛋白、前白蛋白、胆碱酯酶、凝血时间国际标准化比值、血氨、甲胎蛋白等）的差异。2组间比较采用卡方或非参数检验进行分析。结果 HBeAg阳性与阴性乙型肝炎相关慢加急性肝功能衰竭患者预后无明显差异（P＝0.158），检验指标中前白蛋白、甲胎蛋白、国际标准化比值在治疗有效组与无效组之间有明显差异（P＜0．0001，P＝0．0005，P＜0.0001），进一步做ROC曲线，AUC值：前白蛋白，0．875；甲胎蛋白，0．795；国际标准化比值，0．792。结论人工肝支持治疗下HBeAg阳性与阴性乙型肝炎相关慢加急性肝功能衰竭患者预后无明显差异，前白蛋白、甲胎蛋白、凝血时间国际标准化比值作为乙型肝炎相关ACLF预后判断的指标具有一定准确性。
목적：탐토인공간치료하을형간염상관만가급성간공능쇠갈적근기예후급기여HBeAg등각항림상검험지표지간적관계。위급시、준학판정을형간염상관만가급성간공능쇠갈예후제공삼고。방법회고성분석81례경체외인공간지지급내과종합치료을형간염상관만가급성간공능쇠갈환자（기중HBeAg음성자55례，HBeAg양성자26례）림상자료，분석불동HBeAg상태환자예후급각항검험지표（ALT、AST、TBil、백단백、전백단백、담감지매、응혈시간국제표준화비치、혈안、갑태단백등）적차이。2조간비교채용잡방혹비삼수검험진행분석。결과 HBeAg양성여음성을형간염상관만가급성간공능쇠갈환자예후무명현차이（P＝0.158），검험지표중전백단백、갑태단백、국제표준화비치재치료유효조여무효조지간유명현차이（P＜0．0001，P＝0．0005，P＜0.0001），진일보주ROC곡선，AUC치：전백단백，0．875；갑태단백，0．795；국제표준화비치，0．792。결론인공간지지치료하HBeAg양성여음성을형간염상관만가급성간공능쇠갈환자예후무명현차이，전백단백、갑태단백、응혈시간국제표준화비치작위을형간염상관ACLF예후판단적지표구유일정준학성。
Objective To investigate the short -term prognosis in hepatitis B virus (HBV)-related acute -on -chronic liver failure (ACLF)treated with artificial liver support system (ALSS)and its relationship with clinical indices including HBeAg and to provide refer-ence for the timely,accurate prognostic evaluation of HBV-related ACLF.Methods A retrospective analysis was performed on the clinical data of 81 patients with HBV-related ACLF (55 HBeAg-negative cases and 26 HBeAg-positive cases)who received ALSS treatment and comprehensive medical treatment.The HBeAg-negative cases and HBeAg-positive cases were compared in terms of treatment outcome and laboratory indices including alanine aminotransferase,total bilirubin,albumin,prealbumin (PA),cholinesterase,international normalized ratio (INR),blood ammonia,and alpha-fetoprotein (AFP).Comparison between two groups was made by chi-square test or non-para-metric test.Results There was no significant difference in treatment outcome between the HBeAg-negative cases and HBeAg-positive cases (P=0.158).There were significant differences in PA,AFP,and INR between the patients with response to treatment and those with-out response to treatment (P<0.000 1,P=0.000 5,and P<0.000 1).The receiver operating characteristic (ROC)curves of PA,AFP, and INR were drawn,and their areas under the ROC curves were 0.875,0.795,and 0.792,respectively.Conclusion There is no signifi-cant difference in treatment outcome between HBeAg-positive and HBeAg-negative patients with HBV-related ACLF treated with ALSS. PA,AFP,and INR can be used as accurate indices for prognostic evaluation of HBV-related ACLF.