目的 初步探讨乙型肝炎相关慢加急性肝衰竭( HBV - ACLF)患者血清肝纤维化、肝功能、病毒学指标及甲胎蛋白(AFP)水平与预后的关系.方法 根据预后将185例HBV - ACLF患者分为好转组(116例)和无效组(69例),检测血清肝纤维化和肝功能指标、病毒学指标、AFP水平,分析肝纤维化等指标与预后的关系.结果 好转组和无效组性别、HBV基因型、HBeAg阳性率、HBV DNA载量、ALT、Alb、CHE比较差异无统计学意义.好转组和无效组平均年龄分别为(43.3 +10.1)岁和(48.7±10.1)岁,TBil分别为(295.9±99.6) μmol/L、(355.4±136.8) μmol/L,凝血酶原活动度(PTA)分别为( 34.5±7.9)％、(30.4±7.6)％,AFP分别为85(9～4760)ng/L、26(4～529) ng/L,差异皆有统计学意义(P值分别为0.006、0.009、0.0007、0.000),肝纤维化指标中,透明质酸(HA)、Ⅲ型前胶原(PcⅢ)与Ⅳ型胶原(C-Ⅳ)好转组和无效组差异无统计学意义,层粘连蛋白(LN)好转组和无效组分别为657(45～1616)μg/L、306( 29～1724) μg/L,差异有统计学意义(P＜0.001).结论 血清LN、AFP、TBil、PTA水平、年龄可能对HBV感染慢加急性肝衰竭患者的预后判断有一定意义.%Objective To study the relation of liver fibrosis indicators and prognosis in hepatitis B virus - related acute on chronic liver failure (HBV - ACLF). Methods One - hundred - eighty - five cases of HBV - ACLF diagnosed and treated between October 2008 and October 2010 were classified according to prognosis: improved group (n = 116) and ineffective group {n = 69). Serum markers of liver fibrosis, virus replication, and liver function were measured to analyze their relation with prognosis. Results There was no difference in sex, HBV genotype, positivity rate of HBV e antigen, HBV DNA load, or levels of alanine aminotransferase, albumin, cholinesterase, hyaluronic acid, type IV collagen, or human procollagen peptide Ⅲ between the improved and ineffective groups. However, the improved group showed higher average age (years: 43.3 ± 10. 1 vs. ineffective group; 48.7 ± 10. 1, P =0. 006) , level of total bilirubin (TBil; u.mol/L: 295. 9 99. 6 vs. 355.4 ± 136. 8, P = 0. 009), prothrombin activity (PTA; % : 34. 5 ± 7. 9 vs. ineffective group: 30.4 ±7.6 P = 0.0007), alpharn-fetoprotein (AFP; ng/L: 85 (range: 9 - 4760) vs. ineffective group: 26 (4-529), P<0.001), and laminin (LN: μg/L: 657 (45-1616) vs. 306 (29-1724),P<0.001. Conclusion LN, AFP, TBil and PTA levels and age may be effective prognostic markers for HBVrn- ACLF patients.
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