摘要
目的探讨在人工肝治疗中慢加急性肝衰竭前期(pre-ACLF)患者是否较慢加急性肝衰竭(ACLF)患者更具生存优势。方法本研究为一项回顾性、多中心、观察性队列研究。连续性收集2019年1月至2020年12月南昌市第九医院、赣州市第五人民医院及宜春学院第二附属医院具有血清乙肝表面抗原阳性至少持续6个月以上、血清总胆红素≥171μmol/L和至少行1次人工肝治疗特征的患者,分为pre-ACLF组52例与ACLF组233例,随访12周,分析其生存情况及预后影响因素。生存资料采用Kaplan-Meier法和Cox回归进行分析。结果pre-ACLF组的12周死亡率(5.8%,3/52)不仅低于ACLF组(34.8%,81/233),也同时低于ACLF早期组(19.9%,30/151)、中期组(57.9%,33/57)和晚期组(72.0%,18/25),差异有统计学意义(P<0.05)。12周生存分析中,pre-ACLF组不仅优于ACLF组,也同时优于ACLF早期组、中期组和晚期组,差异有统计学意义(P<0.05)。Cox回归分析显示,pre-ACLF、血甲胎蛋白、血钠、年龄、血白细胞及血总胆红素是患者死亡的独立预测因素,差异有统计学意义(P<0.05),其中pre-ACLF组患者的死亡风险仅为ACLF组患者的0.238倍。结论与ACLF组患者相比,pre-ACLF组患者是人工肝治疗的生存优势人群,pre-ACLF可能是人工肝治疗的黄金窗口期。
Objective To investigate whether patients with acute-on-chronic preliver failure(pre-ACLF)have survival advantage compared to patients with acute-on-chronic liver failure(ACLF)in artificial liver treatment.Methods A retrospective,multicenter and observational cohort study was conducted.Patients with serum hepatitis B surface antigen-positive for at least 6 months,serum total bilirubin≥171μmol/L and receiving at least one session of artificial liver treatment,were enrolled from January 2019 to December 2020 consecutively.Fifty-two patients were included in the pre-ACLF group,and 233 patients in the ACLF group.All patients were followed up for 12 weeks,and the survival and prognostic factors were analyzed.Kaplan Meier method and Cox regression were used to analyse the survival data.Results The 12-week mortality of the pre-ACLF group(5.8%,3/52)was lower than that of the ACLF group(34.8%,81/233),and also lower than that of early stage of ACLF group(19.9%,30/151),middle stage of ACLF group(57.9%,33/57)and late stage of ACLF group(72.0%,18/25),respectively(all P<0.05).Survival analysis at 12 weeks showed that the survival for pre-ACLF group was better than ACLF group,and also better than that for early,middle and late stage of ACLF group,respectively(all P<0.05).Cox regression anal-ysis showed that pre ACLF,serum alpha fetoprotein,serum sodium,age,blood leukocytes and total bilirubin were independent predictors of death(all P<0.05),and the death risk of pre-ACLF patients was only 0.238 times that of ACLF patients.Conclusion Compared with ACLF patients,pre-ACLF patients are the survival advantage group of artificial liver treatment.Therefore,pre-ACLF may be the golden window of artificial liver treatment.
作者
朱龙川
曾敬科
袁桂才
邹波
甘达凯
熊墨龙
ZHU Longchuan;ZENG Jingke;YUAN Guicai;ZOU Bo;GAN Dakai;XIONG Molong(Department of Severe Liver Disease,the Ninth Hospital of Nanchang,Nanchang 330002,China;不详)
出处
《实用医学杂志》
CAS
北大核心
2022年第19期2434-2439,共6页
The Journal of Practical Medicine
基金
江西省卫生健康委科技计划(编号:202140134)。
关键词
慢加急性肝衰竭
肝衰竭前期
人工肝
生存优势
预后
acute-on-chronic liver failure
pre-liver failure
artificial liver
survival advantage
prognosis
