HBV相关性肝硬化患者急性慢性肝功能衰竭发生的不同沉淀事

StephenW

Risk of different precipitating events for progressing to acute-on-chronic liver failure in HBV-related cirrhotic patients

    Shan Yin, Shi Jin Wang, Wen Yi Gu, Yan Zhang, Liu Ying Chen andHai Li*

Version of Record online: 29 JUN 2017

DOI: 10.1111/1751-2980.12480

© 2017 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd

Issue
Journal of Digestive Diseases

Volume 18, Issue 5, pages 292–301, May 2017


Author Information

    Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China

Email: Hai Li ([email protected])

*Correspondence to: Hai LI, Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, 145 Middle Shandong Road, Shanghai 200001, China. Email: [email protected]

    Conflict of interest: None.


Keywords:

    acute-on-chronic liver failure;hepatitis B virus ;liver cirrhosis;precipitating event

OBJECTIVE

Acute-on-chronic liver failure (ACLF) is a distinct syndrome that develops in patients with cirrhosis and acute decompensation (AD). This study focused on the precipitating events (PEs) of hepatitis B virus (HBV)-related cirrhotic patients diagnosed as ACLF based on the Chronic Liver Failure Consortium organ failure (CLIF-C OF) score.
METHODS

Hospitalized patients with HBV-related cirrhosis and AD were retrospectively included. The patients’ characteristics, laboratory test results, PEs, CLIF-C OF score and short-term prognosis were evaluated.
RESULTS

Of the 890 patients enrolled 300 (33.7%) were diagnosed as ACLF and 590 (66.3%) without ACLF. ACLF patients had a higher incidence of PEs than those without ACLF. The ACLF patients were more prone to having PEs of bacterial infection (P < 0.001), HBV reactivation (P < 0.001), active alcoholism (P = 0.036) and superimposed hepatitis virus infection (P = 0.031), whereas portal vein thrombosis (P = 0.002) were less common in the non-ACLF group. ACLF patients with the top four single PEs had diverse types of organ failures. However, they shared a similar short-term prognosis. While in patients without PEs the ACLF group had higher systemic inflammation and deterirated outcomes compared with the non-ACLF group.
CONCLUSIONS

PEs of bacterial infection, HBV reactivation, active alcoholism and superimposed hepatitis virus infection, but not GI hemorrhage or portal vein thrombosis, were risk factors for ACLF. There may be two types of patients with ACLF based on the differences in the clinical manifestation of the disease.

StephenW

HBV相关性肝硬化患者急性慢性肝功能衰竭发生的不同沉淀事件的风险

    山阴，王金金，文一贵，严章，刘英陈，海莉*

在线记录版：2017年6月29日

DOI：10.1111 / 1751-2980.12480

©2017中国医学会上海分会，中国消化科学学会，上海交通大学医学院附属仁济医院和约翰·威廉·儿子澳大利亚有限公司

问题
消化疾病杂志

第18卷第5期，第292-301页，2017年5月


作者资料

    上海交通大学医学院仁济医院卫生部消化内科，肝病科重点实验室，上海消化病研究所上海市

电邮：Hai Li（[email protected]）

*通讯地址：上海交通大学医学院附属医院卫生部消化内科，肝病科，胃肠病与肝病科，上海200001，山东中山145号，上海消化病研究所，中国。电邮：[email protected]

    利益冲突：无。


关键词：

    急性肝衰竭;乙型肝炎病毒;肝硬化;沉淀事件

目的

急性慢性肝衰竭（ACLF）是在肝硬化和急性代偿失调（AD）患者中发展的独特综合征。本研究着重于基于慢性肝衰竭联合器官功能衰竭（CLIF-C OF）评分诊断为ACLF的乙型肝炎病毒（HBV）相关肝硬化患者的沉淀事件（PE）。
方法

回顾性地纳入住院的HBV相关性肝硬化和AD患者。评估患者特征，实验室检查结果，PE，CLIF-C OF评分和短期预后。
结果

在890例患者中，有300例（33.7％）被诊断为ACLF，590例（66.3％）无ACLF。 ACLF患者的PE发生率高于无ACLF患者。 ACLF患者更容易发生细菌感染（P <0.001），HBV再激活（P <0.001），活动性酒精中毒（P = 0.036）和重叠型肝炎病毒感染（P = 0.031），而门静脉血栓形成（P = 0.002）在非ACLF组中较不常见。前四名单一PE的ACLF患者有不同类型的器官衰竭。但是，他们也有类似的短期预后。而在没有PE的患者中，与非ACLF组相比，ACLF组具有更高的全身炎症和阻止结局。
结论

细菌感染的PE，HBV再激活，活动性酒精中毒和叠加性肝炎病毒感染，但不是GI出血或门静脉血栓形成，是ACLF的危险因素。基于疾病临床表现的差异，可能有两种ACLF患者。