CAJ | 학술논문

目的：揭示乙型肝炎肝衰竭患者的临床特征，探讨乙型肝炎肝衰竭患者病情进展和预后预测指标，分析乙型肝炎肝衰竭适用的治疗方法。方法：收集并分析我科2012年7月至2014年3月收治入院的100例乙型肝炎肝衰竭患者的临床资料、实验室检查指标、并发症、生存率、治疗措施以及不良事件。结果：100例乙型肝炎肝衰竭患者中，HBV 相关慢加急性肝衰竭（HBV－ACLF）和 HBV相关慢性肝衰竭（HBV－CLF）分别为86例和14例，无急性和亚急性肝衰竭病例。 HBV－ACLF 和 HBV－CLF 在性别比例、TBil、Alb、PT、HBV DNA、HBeAg 阳性率、自发性腹膜炎（SBP）发生率、4周死亡率等方面差异无显著性意义。但是与 HBV－ACLF 相比，HBV－CLF 发病年龄高（P ＜0．05），PLT 水平低（P ＜0．05），腹水（Asitice）、肝性脑病（HE）、消化道出血（Bleeding）的发生率较高（P ＜0．05）。而与HBV－CLF 比较，HBV－ACLF 在诊断时具有更高的 ALT 水平（P ＜0．05）。另外，血清 Na＋水平越低，生存率越低。发生 HE、Bleeding、SBP 患者4周死亡率明显高于未发生并发症者。使用核苷（酸）类似物抗病毒患者与未使用此药物患者比较，短期（4周）实验室检查指标除 HBV DNA 外，其余各项及生存率差异均无显著性意义。结论：ACLF 和 CLF 为乙型肝炎肝衰竭的主要临床亚型。血清 Na＋、HE、SBP、Bleeding 是患者近期预后的独立预测因素。乙型肝炎肝衰竭患者使用核苷（酸）类似物抗病毒治疗安全有效，持续的病毒抑制可能改善患者的远期预后。
목적：게시을형간염간쇠갈환자적림상특정，탐토을형간염간쇠갈환자병정진전화예후예측지표，분석을형간염간쇠갈괄용적치료방법。방법：수집병분석아과2012년7월지2014년3월수치입원적100례을형간염간쇠갈환자적림상자료、실험실검사지표、병발증、생존솔、치료조시이급불량사건。결과：100례을형간염간쇠갈환자중，HBV 상관만가급성간쇠갈（HBV－ACLF）화 HBV상관만성간쇠갈（HBV－CLF）분별위86례화14례，무급성화아급성간쇠갈병례。 HBV－ACLF 화 HBV－CLF 재성별비례、TBil、Alb、PT、HBV DNA、HBeAg 양성솔、자발성복막염（SBP）발생솔、4주사망솔등방면차이무현저성의의。단시여 HBV－ACLF 상비，HBV－CLF 발병년령고（P ＜0．05），PLT 수평저（P ＜0．05），복수（Asitice）、간성뇌병（HE）、소화도출혈（Bleeding）적발생솔교고（P ＜0．05）。이여HBV－CLF 비교，HBV－ACLF 재진단시구유경고적 ALT 수평（P ＜0．05）。령외，혈청 Na＋수평월저，생존솔월저。발생 HE、Bleeding、SBP 환자4주사망솔명현고우미발생병발증자。사용핵감（산）유사물항병독환자여미사용차약물환자비교，단기（4주）실험실검사지표제 HBV DNA 외，기여각항급생존솔차이균무현저성의의。결론：ACLF 화 CLF 위을형간염간쇠갈적주요림상아형。혈청 Na＋、HE、SBP、Bleeding 시환자근기예후적독립예측인소。을형간염간쇠갈환자사용핵감（산）유사물항병독치료안전유효，지속적병독억제가능개선환자적원기예후。
Objective:To investigate the clinical characteristics of HBV-related liver failure (HBV-LF), to explore the predictors for progress and prognosis, and to analyze the applicable therapeutic regimes of HBV-LF.Methods:All the patients who suffered from HBV-LF hospitalized in our clinic from July 2012 to March 2014 were included in this study.The clinical manifestations, laboratory findings, compli-cations, outcomes, mortality, treatment interventions, and adverse events were collected and analyzed.Results:There were all together 100 patients with HBV-LF, 86 of which suffered from acute-on-chronic liver failure (ACLF), and the rest 14 patients suffered from chronic liver failure (CLF), HBV related acute or subacute liver failure were not diagnosed.There were no significant differences between HBV-ACLF and HBV-CLF in the context of gender,total bilirubin, albumin, prothrombin time, HBV DNA, HBeAg status, Spontaneous bacterial Perito-nitis (SBP) rate, and Mortality within four weeks (P >0.05).Elder age (P <0.05), lower PLT levels (P <0.05), and higher incidence (P <0.05) of ascites,hepatic encephalopathy (HE), and gastrointestinal bleeding were revealed in patients with HBV-CLF than those with HBV-ACLF, whereas patients with HBV-ACLF exhibited higher ALT levels than those with HBV-CLF when they were diagnosed.Lower ser-um sodium levels always leaded to lower survival rate (P <0.05).The mortality at week four was significantly higher in patients with compli-cations of HE, gastrointestinal bleeding, or SBP than those without complications.No significant difference was found between patients re-ceived nucleos(t)ide analogues treatment or not, in the aspects of laboratory test and survival rates at week four, except HBV DNA loads. Conclusion:ACLF and CLF are the main clinical subtypes of HBV-LF.Serum sodium, HE, SBP, and bleeding are independent predictors of short-term prognosis in patients with HBV-LF.Nucleos(t)ide analogues are safe and effective for patient with HBV-LF and may improve their <br> long term prognosis through sustained suppression of HBV.