Clinical effect of integrated traditional Chinese and Western medicine therapy in patients with hepatitis B virus-related acute-on-chronic liver failure complicated by hepatic encephalopathy
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摘要:
目的探讨中西医结合治疗HBV相关慢加急性肝衰竭(ACLF)合并肝性脑病(HE)患者8周病死率情况,分析影响其预后的独立危险因素。方法选取2012年1月-2015年2月18家医院收治的HBV-ACLF患者,采用随机对照设计分为试验组和对照组,分别给予中西医结合治疗和单纯西医综合治疗,纳入所有0周合并HE的患者125例。观察2组8周病死率情况。计量资料2组间比较采用t检验或Mann-Whitney U检验,计数资料2组间比较采用χ2检验,生存分析采用Kaplan-Meier方法及logrank检验,危险因素分析采用Cox比例风险回归模型。结果试验组及对照组8周病死率分别为27.5%、50.0%(χ2=5.630,P=0.018),8周内中位生存时间分别为41.2 d、28.4 d,累积生存概率分别为60.4%、32.5%(χ2=6.187,P=0.013);Cox回归分析结果显示与对照组相比,试验组是HBV-ACLF合并HE患者预后的保护因素[风险比(HR)=0.424,P=0.018,95%可信区间(95%CI):0.2080
Abstract:Objective To investigate the 8-week mortality rate of patients with hepatitis B virus (HBV) -related acute-on-chronic liver failure (ACLF) complicated by hepatic encephalopathy (HE) treated with integrated traditional Chinese and Western medicine therapy, as well as independent prognostic factors.Methods A total of 125 HBV-ACLF patients with HE who were admitted to 18 hospitals from January 2012 to February 2015 were enrolled and divided into trial group and control group using a randomized controlled design.The patients in the trial group were given integrated traditional Chinese and Western medicine therapy, and those in the control group were given Western medicine therapy alone.The 8-week mortality rate was observed for both groups.The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups; the chi-square test was used for comparison of categorical data between groups; the Kaplan-Meier method and the log-rank test were used for survival analysis; the Cox proportional hazards regression model was used for the analysis of risk factors.Results The 8-week mortality rate was 27.5% in the trial group and 50.0% in the control group (χ2= 5.630, P = 0.018) , the median survival time was 41.2 days in the trial group and 28.4 days in the control group, and the 8-week cumulative probability of survival was 60.4% in the trial group and 32.5% in the control group (χ2= 6.187, P = 0.013) .The Cox regression analysis showed that compared with the control group, the trial group was a protective factor in patients with HBV-ACLF complicated by HE (hazard ratio [HR]= 0.424, 95% confidence interval [CI]:0.208-0.864, P = 0.018) .There were significant differences between the two groups in total bilirubin (TBil) (HR = 1.063, 95% CI:1.002-1.128, P = 0.042) , prothrombin activity (PTA) (HR = 0.942, 95% CI:0.890-0.998, P = 0.044) , ACLF stage (HR = 2.737, 95% CI:1.287-5.818, P = 0.009) , and the presence or absence of gastrointestinal hemorrhage (HR = 5.291, 95% CI:1.736-16.126, P = 0.003) .Conclusion Traditional Chinese medicine treatment can significantly reduce the 8-week mortality rate of HBV-ACLF patients with HE, increase their 8-week survival probability, and prolong survival time.TBil, PTA, ACLF stage, and gastrointestinal hemorrhage are independent prognostic factors.
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Key words:
- liver failure /
- hepatic encephalopathy /
- hepatitis B virus /
- TCM WM therapy
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