CLIF-C OFs 在非乙型肝炎相关慢性肝病急性失代偿患者中鉴别慢加急性肝功能衰竭的临床研究

摘要

背景：近期欧洲一项针对酒精和丙型肝炎肝硬化急性失代偿（AD）患者的前瞻性研究表明，慢性肝功能衰竭联盟-器官功能衰竭评分（CLIF-C OFs）是区分慢加急性肝功能衰竭（ACLF）的有效诊断标准。目的：探讨 CLIF-C OFs在非乙型肝炎相关慢性肝病并发 AD 患者中鉴别 ACLF 的有效性。方法：筛选并纳入2005年1月-2010年12月上海仁济医院非乙型肝炎相关慢性肝病 AD 患者274例，按 CLIF-C OFs 标准分为入院时 ACLF 组、入院28 d-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死亡率。结果：入院时ACLF 患者40例，27例为入院28 d-ACLF 组，非 ACLF 组207例。ACLF 组 TB、Cr、INR、ALT、AST、ALB、WBC、Child-Pugh、CTP、MELD、MELD-Na 评分均显著高于非 ACLF 患者（P <0.05），且年龄更轻（P <0.01）。ACLF 组肝、肾、脑、凝血、循环、肺衰竭的发生率均显著高于非 ACLF 组（P <0.01），28 d 和90 d 死亡率均显著升高（P <0.001）。入院28 d-ACLF 组上述指标与入院时 ACLF 组相比差异均无统计学意义（P >0.05）。入院时 TB 水平、28 d 内合并感染为进展为 ACLF 的危险因素（P <0.05）。结论：非乙型肝炎相关慢性肝病并发 AD 患者中确实存在一群疾病程度更严重的 ACLF 群体，CLIF-C OFs 标准可将 ACLF 患者从非乙型肝炎相关慢性肝病并发 AD 患者中区分出来。%Background:A recent perspective European study has shown that Chronic Liver Failure-Consortium Organ Failure score(CLIF-C OFs)is an effective diagnostic criteria for acute-on-chronic liver failure(ACLF)in alcoholic or hepatitis C virus patients with acute decompensation(AD). Aims:To assess the efficacy of CLIF-C OFs for distinguishing ACLF in non-hepatitis B virus(HBV)-related chronic liver disease patients with AD. Methods:A total of 274 consecutive non-HBV-related chronic liver disease patients with AD from Jan. 2005 to Dec. 2010 at Shanghai Ren Ji Hospital were enrolled. Patients were divided into three groups:ACLF at admission,ACLF developed within 28-day and non-ACLF according to CLIF-C OFs criteria. Clinical and biochemistry characteristics,severity of the disease and 28-day and 90-day mortality data between ACLF and non-ACLF groups were analyzed. Results:Of the patients assessed,40 had ACLF at admission,27 had ACLF developed within 28-day,207 remained not having ACLF. Patients in ACLF group had higher TB,Cr,INR,ALT,AST,ALB,WBC,score of Child-Pugh,CTP,MELD,MELD-Na than non-ACLF patients(P <0. 05),and were younger in age(P < 0. 01). Incidences of hepatic,renal,cerebral,coagulation,circulation and lung failure,28-day mortality,90-day mortality were significantly higher in ACLF group than in non-ACLF patients( P <0. 01). However,no significant differences were seen in the characteristics mentioned above between ACLF at admission group and ACLF developed at 28-day group(P > 0. 05). TB level at admission and infection occurred within 28-day were the risk factors for developing ACLF(P < 0. 05). Conclusions:ACLF constitutes a more severe subgroup in non-HBV-related chronic liver disease patients with AD,and CLIF-C OFs could help to distinguish ACLF patients out from non-HBV-related chronic liver disease patients with AD.