本文選題：乙型肝炎病毒 + 慢加急性肝衰竭　； 參考：《寧夏醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的探討乙肝相關(guān)性慢加急性肝衰竭(HBV-ACLF)患者的發(fā)病誘因及臨床因素對預(yù)后的影響。方法對寧夏醫(yī)科大學(xué)總醫(yī)院感染性疾病科2006年1月1日至2015年12月31收治的117例HBV-ACLF患者進行回顧性分析,并收集一般資料:包括性別、年齡、民族、發(fā)病誘因、并發(fā)癥、是否抗病毒治療以及實驗室檢查:總膽紅素(TBIL)、尿素氮(BUN)、肌酐(SCr)、白細胞(WBC)、血小板(PLT)、血清Na+、K+、凝血酶原活動度(PTA)、甲胎蛋白(AFP)、乙肝病毒載量(HBV DNA)、乙肝表面抗原(HBs Ag)、e抗原(HBeAg)、腹部B超或CT等。結(jié)果(1)117例HBV-ACLF患者中男性101例,女性16例,漢族88例,回族29例,治療好轉(zhuǎn)50例,惡化/死亡67例。(2)HBV-ACLF發(fā)病的誘因中,自行停用或不規(guī)律服用抗病毒藥物所致的HBV-ACLF增多。好轉(zhuǎn)組和惡化/死亡組的誘因構(gòu)成比無差異(p0.05)。(3)惡化/死亡組年齡高于好轉(zhuǎn)組,且年齡≤50歲組好轉(zhuǎn)率明顯高于50歲組,差異有統(tǒng)計學(xué)意義(p0.05)。(4)好轉(zhuǎn)組的甲胎蛋白(AFP)水平明顯高于惡化/死亡組,差異有統(tǒng)計學(xué)意義(p0.05)。且AFP越高,預(yù)后越好。(5)肝硬化組和慢性肝炎組兩者預(yù)后無統(tǒng)計學(xué)意義(p0.05)。(6)隨臨床分期進展,好轉(zhuǎn)率逐漸下降,且各組間差異有統(tǒng)計學(xué)意義(p0.05)。(7)e抗原陽性與否和HBV DNA水平高低在好轉(zhuǎn)組和惡化/死亡組之間差異無統(tǒng)計學(xué)意義(p0.05)。(8)抗病毒治療組好轉(zhuǎn)率明顯高于未抗病毒治療組,差異有統(tǒng)計學(xué)意義(p0.05)。(9)惡化/死亡組發(fā)生肝性腦病、肝腎綜合征、電解質(zhì)紊亂的概率顯著高于好轉(zhuǎn)組。且惡化/死亡組并發(fā)癥的發(fā)生率,尤其是發(fā)生3種或3種以上的發(fā)生率明顯高于治療好轉(zhuǎn)組差異具有統(tǒng)計學(xué)意義(p0.05)。(10)影響HBV-ACLF患者預(yù)后的因素進行Logistic回歸分析發(fā)現(xiàn),臨床分期、年齡是影響疾病的預(yù)后的危險因素。臨床分期中疾病早期人群治療后好轉(zhuǎn)率是晚期人群的13.323倍;年齡≤50歲的人群治療后好轉(zhuǎn)率是年齡50歲人群的4.41倍。結(jié)論(1)自行停用或不規(guī)律服用抗病毒藥物誘發(fā)的乙肝相關(guān)性慢加急性肝衰竭患者增多;(2)慢加急性肝衰竭患者年齡越大,臨床分期越晚,并發(fā)癥越多,預(yù)后越差;(3)慢加急性肝衰竭患者甲胎蛋白水平越高、經(jīng)過抗病毒治療者,預(yù)后越好。
[Abstract]:Objective to investigate the predisposing factors and the influence of clinical factors on the prognosis of patients with chronic hepatitis B associated with acute liver failure (HBV-ACLF). Methods A retrospective analysis of 117 HBV-ACLF patients admitted to the Department of Infectious Diseases, General Hospital of Ningxia Medical University from January 1, 2006 to December 31, 2015 was carried out, and general data were collected, including sex, age, nationality, cause of onset, complications. Antiviral therapy and laboratory tests: total bilirubin (TBIL), urea nitrogen (bun), creatinine (SCR), white blood cell (WBC), platelet (PLT), serum Na, Prothrombin activity (PTA), alpha-fetoprotein (AFP), HBV DNA, hepatitis B surface antigen (HBs Ag), HBeAg, abdominal B ultrasound or CT, etc. Results (1) among 117 HBV-ACLF patients, 101 were male, 16 were female, 88 were Han nationality, 29 were Hui, 50 were better and 67 were worse / dead. (2) HBV-ACLF was increased due to withdrawal or irregular administration of antiviral drugs. There was no difference in the inducement composition ratio between the improvement group and the deterioration / death group (p0. 05). (3). The age of the deterioration / death group was higher than that of the improvement group, and the improvement rate of the age 鈮，

本文編號：2088865