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目的探讨乙型肝炎病毒引起的慢加急性肝衰竭(ACLF)患者预后的影响因素。方法根据预后将253例ACLF患者分为治疗有效组(84例)和无效组(169例),统计患者的一般资料、常规化验指标、肝功能指标和乙肝病毒学指标,回归分析各项指标与预后的关系。结果有效组和无效组性别、ALT、AST、前白蛋白、总胆固醇、血糖、AFP、血红蛋白、血小板、HBV DNA计量和e抗原(HBeAg)阳性率在两组间差异均无统计学意义(均P>0.05);有效组和无效组年龄、总胆红素水平、白蛋白、肌酐、凝血酶原活动度、纤维蛋白原和住院时间差异有统计学意义(P均<0.05)。患者年龄越大,预后越差(χ2=9.426,P<0.05)。Logistic多元回归分析表明,总胆红素、PTA、纤维蛋白原、肌酐和住院时间是ACLF的独立影响因素(P均<0.05)。结论年龄、血清总胆红素、白蛋白、肌酐、凝血酶原活动度、纤维蛋白原和住院时间影响乙型肝炎病毒引起的慢加急性肝衰竭患者的预后,其中总胆红素、PTA、纤维蛋白原、肌酐、住院时间影响显著。
Objective To investigate the influencing factors of prognosis of patients with chronic and acute liver failure (ACLF) caused by hepatitis B virus. Methods According to the prognosis, 253 patients with ACLF were divided into two groups: the treatment group (84 cases) and the ineffective group (169 cases). The general data, routine laboratory tests, liver function tests and HBV markers were statistically analyzed. Prognosis of the relationship. Results The positive rates of ALT, AST, prealbumin, total cholesterol, blood glucose, AFP, hemoglobin, platelet, HBV DNA and e antigen (HBeAg) in the effective group and the ineffective group were not significantly different P> 0.05). There were significant differences in age, total bilirubin level, albumin, creatinine, prothrombin activity, fibrinogen and hospital stay between the effective and ineffective groups (all P <0.05). The older the patient, the worse the prognosis (χ2 = 9.426, P <0.05). Logistic multivariate regression analysis showed that total bilirubin, PTA, fibrinogen, creatinine and length of hospital stay were independent factors of ACLF (all P <0.05). Conclusions Age, serum total bilirubin, albumin, creatinine, prothrombin activity, fibrinogen and length of stay affect the prognosis of patients with chronic and acute liver failure caused by hepatitis B virus. The total bilirubin, PTA, Fibrinogen, creatinine, hospital stay significantly affected.