乙型肝炎病毒相关慢加急性肝衰竭患者的长期预后：一项回顾性研究。
Long-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure: a retrospective study.
机构信息
Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, 600# Tianhe Road, Guangzhou City, Guangdong Province, China.
Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
出版信息
BMC Gastroenterol. 2022 Apr 2;22(1):162. doi: 10.1186/s12876-022-02239-4.
BACKGROUND
The long-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is not well characterised. We assessed long-term outcomes and the associated risk factors of HBV-ACLF patients in southern China.
METHODS
We retrospectively analysed clinical data, adverse events, and clinical endpoint events of HBV-ACLF patients treated at our department between January 2014 and December 2018.
RESULTS
A total of 616 (52.3%) patients with cirrhosis and 561 (47.7%) patients without cirrhosis were included. In 973 (83%) patients, the disease was associated only with HBV, while 204 (17%) patients had two or more aetiological factors. The proportion of patients receiving antiviral treatment for HBV was low (20.3%). Further analyses indicated that patients without cirrhosis had a significantly lower 90-day liver transplantation-free mortality and higher 5-year survival rate than those with cirrhosis (59.5% vs. 27.6%; 62% vs. 36%; P < 0.05). Remarkably, self-withdrawal of nucleos(t)ide analog (NA) was an independent risk factor for short-term prognosis. Age, cirrhosis at admission, and platelet level were closely related to long-term prognosis of HBV-ACLF patients.
CONCLUSION
The proportion of HBV-ACLF patients receiving antiviral treatment is very low in south China. Cirrhosis at admission has a significant effect on both short-term and long-term prognosis. No significant improvement in the short-term prognosis of HBV-ACLF patients was observed compared with previous studies. More comprehensive access to antiviral treatment and long-term surveillance of HBV patients are key imperatives to reduce the incidence of HBV-ACLF and improve the prognosis. Trial Registration The trial was registered at ClinicalTrials.gov (CT.gov identifier: NCT04231565) on May 13, 2020: https://register.
CLINICALTRIALS
gov/prs/app/action/SelectProtocol?sid=S0009OZY&selectaction=Edit&uid=U00036P1&ts=2&cx=27seqt.
背景
乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）患者的长期预后尚不清楚。本研究评估了中国南方 HBV-ACLF 患者的长期结局和相关危险因素。
方法
我们回顾性分析了 2014 年 1 月至 2018 年 12 月在我科治疗的 HBV-ACLF 患者的临床资料、不良事件和临床终点事件。
结果
共纳入 616 例（52.3%）肝硬化患者和 561 例（47.7%）无肝硬化患者。在 973 例（83%）患者中，疾病仅与 HBV 相关，而 204 例（17%）患者有两种或两种以上病因。接受 HBV 抗病毒治疗的患者比例较低（20.3%）。进一步分析表明，无肝硬化患者的 90 天无肝移植死亡率显著低于肝硬化患者（59.5%比 27.6%；P<0.05），5 年生存率显著高于肝硬化患者（62%比 36%；P<0.05）。值得注意的是，核苷（酸）类似物（NA）的自我停药是短期预后的独立危险因素。年龄、入院时的肝硬化状态和血小板水平与 HBV-ACLF 患者的长期预后密切相关。
结论
中国南方 HBV-ACLF 患者接受抗病毒治疗的比例非常低。入院时的肝硬化对短期和长期预后均有显著影响。与既往研究相比，HBV-ACLF 患者的短期预后未见明显改善。更全面地获得抗病毒治疗和长期监测 HBV 患者是降低 HBV-ACLF 发病率和改善预后的关键。
试验注册
该试验于 2020 年 5 月 13 日在 ClinicalTrials.gov（CT.gov 标识符：NCT04231565）注册：https://register.
临床试验
gov/prs/app/action/SelectProtocol？sid=S0009OZY&selectaction=Edit&uid=U00036P1&ts=2&cx=27seqt。
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