Li C, Zhu B, Lyu S, You S L
Liver Failure Treatment and Research Centre, 302 Military Hospital, Beijing 100039, China.
Zhonghua Gan Zang Bing Za Zhi. 2018 Feb 20;26(2):130-135. doi: 10.3760/cma.j.issn.1007-3418.2018.02.011.
To investigate the concept of hepatitis B virus (HBV)-related acute-on-chronic pre-liver failure (pre-ACLF), and to develop and evaluate the diagnostic criteria for this disease. A retrospective analysis was performed for the clinical data of 754 patients with severe acute exacerbation (SAE) of HBV-related chronic liver disease, and their clinical features were identified. A multivariate logistic regression analysis was used to determine the risk factors for acute-on-chronic liver failure (ACLF). The inclusion rate of patients with SAE-HBV-related chronic liver disease and the detection rate of ACLF patients were analyzed to evaluate the value of four different versions of diagnostic criteria for pre-liver failure. The t-test, an analysis of variance, the Mann-Whitney U test, and the chi-square test were used for statistical analysis based on data type. The incidence rate of ACLF in the patients with SAE-HBV-related chronic liver disease was 9.9% and the time to progression to ACLF was 12.0 ± 6.7 days. The multivariate logistic regression analysis showed that HBV reactivation (odds ratio [] = 5.118), direct bilirubin ratio (D/T) ( = 1.041), age ( = 1.033), total bilirubin (TBil) ( = 1.005), prothrombin activity (PTA) ( = 0.880), and serum sodium (Na) ( = 0.918) were independent risk factors for ACLF. Group B (51.3 μmol/L < TBil < 171.1 μmol/L and 40%≤PTA < 60%, 4.2%) had a significantly lower incidence rate of ACLF than group A (51.3 μmol/L < TBil < 171.1 μmol/L and PTA < 40%, 13.7%) and group C (TBil > 171.1 μmol/L and 40% < PTA < 60%, 20.3%) ( < 0.001). Group C had a significantly shorter time to progression to ACLF than group A (10.5 ± 6.1 days vs 15.6 ± 7.4 days, = 0.008). A total of 45 patients met the diagnostic criteria developed by Chongqing and the incidence rate of ACLF was 2.2%; 154 patients met the diagnostic criteria developed by Zhejiang and the incidence rate of ACLF was 7.1%; 188 patients met the diagnostic criteria in the Chinese guidelines and the incidence rate of ACLF was 6.4%; 117 patients met the diagnostic criteria for SAE-CHB and the incidence rate of ACLF was 9.4%. At present, these four versions of diagnostic criteria for pre-liver failure are not fully applicable to the clinical practice in China. The diagnostic criteria for HBV-related pre-ACLF should include important assessment indices which affect its progression to ACLF.
探讨乙型肝炎病毒（HBV）相关慢加急性肝衰竭前期（pre-ACLF）的概念，并制定和评估该疾病的诊断标准。对754例HBV相关慢性肝病严重急性加重（SAE）患者的临床资料进行回顾性分析，明确其临床特征。采用多因素logistic回归分析确定慢加急性肝衰竭（ACLF）的危险因素。分析SAE-HBV相关慢性肝病患者的纳入率及ACLF患者的检出率，以评估4种不同版本肝衰竭前期诊断标准的价值。根据数据类型，采用t检验、方差分析、Mann-Whitney U检验和卡方检验进行统计分析。SAE-HBV相关慢性肝病患者中ACLF的发生率为9.9%，进展至ACLF的时间为12.0±6.7天。多因素logistic回归分析显示，HBV再激活（比值比[]=5.118）、直接胆红素比值（D/T）（=1.041）、年龄（=1.033）、总胆红素（TBil）（=1.005）、凝血酶原活动度（PTA）（=0.880）和血清钠（Na）（=0.918）是ACLF的独立危险因素。B组（51.3 μmol/L＜TBil＜171.1 μmol/L且40%≤PTA＜60%，4.2%）ACLF的发生率显著低于A组（51.3 μmol/L＜TBil＜171.1 μmol/L且PTA＜40%，13.7%）和C组（TBil＞171.1 μmol/L且40%＜PTA＜60%，20.3%）（＜0.001）。C组进展至ACLF的时间显著短于A组（10.5±6.1天对15.
