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目的探究欧洲肝病学会提出的适用于以酒精为病因引起的慢加急性肝衰竭诊断标准(CLIF Consortium Organ Failure score,CLIF-C OF)是否适用于乙型肝炎相关的慢加急性肝衰竭。方法筛选并纳入2005年1月至2010年12月上海瑞金医院乙型肝炎相关慢性肝病急性失代偿患者854例,按CLIF-C OF标准分为ACLF组和非ACLF组。分析ACLF组和非ACLF组的临床和实验室指标、病情严重程度和短期病死率。结果 ACLF组262例和非ACLF组592例。ACLF组较非ACLF组年龄大,肝、肾、脑、凝血、循环、呼吸功能衰竭情况均显著高于入院非ACLF组(P<0.01),28 d和90 d病死率均显著升高(27.1%比3.1%、39.6%比4.9%,P<0.01),提示病情更重。结论欧洲肝病学会所提出的评分标准可从乙型肝炎相关慢性肝病合并急性失代偿患者中筛选出一组病情更为危重、病死率更高的慢加急性肝衰竭患者群体。乙型肝炎相关慢性肝病并发急性失代偿患者中确实存在一群疾病程度更严重的ACLF群体,CLIF-C OF标准可将ACLF患者从乙型肝炎相关慢性肝病并发急性失代偿患者中区分出来,以指导临床医生治疗决策。
Objective To investigate whether CLIF-C OF (European Association for the study of the liver) suitable for alcohol-induced etiology is applicable to hepatitis B-related acute and acute liver failure. Methods A total of 854 patients with acute decompensated hepatitis B-related chronic liver disease in Shanghai Ruijin Hospital from January 2005 to December 2010 were selected and divided into ACLF group and non-ACLF group according to CLIF-C OF standard. Clinical and laboratory parameters, severity of illness, and short-term mortality were analyzed in the ACLF and non-ACLF groups. Results There were 262 cases in ACLF group and 592 cases in non-ACLF group. The incidence of liver, kidney, brain, coagulation, circulation and respiratory failure in ACLF group was significantly higher than that in non-ACLF group (P <0.01), and significantly increased at 28 and 90 days (27.1 % Vs 3.1%, 39.6% vs 4.9%, P <0.01), suggesting that the condition is more serious. Conclusions The European Association for the Study of Liver Diseases scoring criteria can be selected from a group of patients with acute and chronic liver failure who are more critically ill and have a higher mortality rate from patients with chronic hepatitis B and acute decompensation. There is indeed a growing group of ACLF colonies in patients with chronic hepatitis B-related acute liver failure who are more severely ill. The CLIF-C OF standard distinguishes ACLF patients from patients with chronic hepatitis B-related acute liver failure who have acute decompensation, To guide clinicians in treatment decisions.