Clinical features of HBV-related liver failure associated with recurrence after withdrawal of nucleos ( t) ide analogues and influencing factors for prognosis
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摘要: 目的研究接受核苷和核苷酸类抗病毒药物治疗的慢性乙型肝炎患者停药复发后进展为肝衰竭的临床特征和预后影响因素。方法回顾性分析2014年1月-2017年12月福建医科大学孟超肝胆医院收治的40例停药复发相关肝衰竭患者的一般资料、抗病毒治疗情况、生化指标和病毒学等临床资料,根据第12周的存活情况分为存活组(n=18)和死亡组(n=22),比较两组患者的临床特征差异。正态分布的计量资料组间比较采用t检验;偏态分布的计量资料组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ2检验。应用logistic回归分析患者停药后复发并进展为肝衰竭的影响因素。结果死亡组与存活组患者停药前中位抗病毒治疗时间、停药至复发时间比较,差异均无统计学意义(P值均>0.05);死亡组中肝硬化患者比例显著高于存活组(81.8%vs 27.8%,χ2=11.831,P=0.001)。存活组患者Alb(t=2.302)、GGT(Z=-3.671)、胆碱酯酶(Z=-2.134)水平均明显高于死亡组,TBil水平(Z=-4.241)、PT(t=-2.727)、国际...Abstract: Objective To investigate the clinical features of chronic hepatitis B ( CHB) patients progressing to liver failure due to recurrence after withdrawal of nucleos ( t) ide analogues and influencing factors for prognosis. Methods A retrospective analysis was performed for the clinical data of 40 patients with liver failure due to recurrence after drug withdrawal who were admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2014 to December 2017, including general information, antiviral therapy, and biochemical and virological data. According to the treatment outcome at week 12, the patients were divided into survival group with 18 patients and death group with 22 patients, and clinical features were compared between the two groups. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of continuous data with skewed distribution between groups. The chi-square test was used for comparison of categorical data between groups. The logistic regression analysis was performed to identify the influencing factors for recurrence and progression to liver failure after drug withdrawal. Results There were no significant differences between the death group and the survival group in median time of antiviral therapy and time from drug withdrawal to recurrence ( P > 0. 05) , and the death group had a significantly higher proportion of patients with liver cirrhosis than the survival group ( 81. 8% vs 27. 8%, χ2= 11. 831, P = 0. 001) . Compared with the death group, the survival group had significantly higher levels of albumin ( t = 2. 302) , gamma-glutamyl transpeptidase ( Z =-3. 671) , and cholinesterase ( Z =-2. 134) and significantly lower total bilirubin ( Z =-4. 241) , prothrombin time ( t =-2. 727) , international normalized ratio ( t =-2. 343) , and Model for End-Stage Liver Disease score ( t =-3. 909) ( all P < 0. 05) . There was a significant difference in acute-on-chronic liver failure ( ACLF) grade between the two groups ( χ2= 18. 425, P < 0. 001) . The logistic regression analysis showed that ACLF grade ( odds ratio [OR] = 9. 865, 95% confidence interval [CI]: 1. 455-67. 370, P = 0. 020) and liver cirrhosis ( OR = 9. 988, 95% CI: 2. 048-48. 709, P = 0. 004) were independent risk factors for the prognosis of liver failure due to recurrence after drug withdrawal. Conclusion Liver failure due to recurrence after drug withdrawal has a high mortality rate, and its prognosis is not associated with antiviral regimen, course of treatment, or virological parameters. Patients with liver cirrhosis and a higher liver failure grade tend to have poorer prognosis. Patients with liver cirrhosis have a high risk after drug withdrawal and should take the medicine for a long time or even for the whole life.
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Key words:
- hepatitis B, chronic /
- liver failure /
- antiviral agents /
- recurrence /
- risk factors
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[1] CHEN L, LI XL, GAN QR, et al.Clinical characteristics of and factors related to relapse in chronic hepatitis B patients after nucleot (s) ide analogues withdrawal[J].Chin J Hepatol, 2013, 21 (11) :825-828. (in Chinese) 陈立, 李孝楼, 甘巧蓉, 等.核苷 (酸) 类似物治疗慢性乙型肝炎停药复发患者的临床特点及其影响因素[J].中华肝脏病杂志, 2013, 21 (11) :825-828. [2] Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, CMA;Severe Liver Diseases and Artificial Liver Group, Chinese Society of Hepatology, CMA.Guideline for diagnosis and treatment of liver failure (2012 version) [J].Chin J Clin Infect Dis, 2012, 5 (6) :321-327. (in Chinese) 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南 (2012年版) [J].中华临床感染病杂志, 2012, 5 (6) :321-327. [3]Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B:A 2015 update[J].J Clin Hepatol, 2015, 31 (12) :1941-1960. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南 (2015年更新版) [J].临床肝胆病杂志, 2015, 31 (12) :1941-1960. [4]JALAN R, SALIBA F, PAVESI M, et al.Development and validation of a prognostic score to predict mortality in patients with acute-onchronic liver failure[J].J Hepatol, 2014, 61 (5) :1038-1047. [5] ARROYO V, MOREAU R, KAMATH PS, et al.Acute-onchronic liver failure in cirrhosis[J].Nat Rev Dis Primers, 2016, 2:16041. [6]WANG YM.Drug withdrawal of antiviral treatment in patients with chronic hepatitis B[J].Chin J Clin Infect Dis, 2010, 3 (2) :68-72. (in Chinese) 王宇明.慢性乙型肝炎抗病毒治疗的停药问题[J].中华临床感染病杂志, 2010, 3 (2) :68-72. [7] European Association for the Study of the Liver.EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection[J].J Hepatol, 2017, 67 (2) :370-398. [8]PAN HY, PAN HY, CHEN L, et al.Ten-year follow-up of hepatitis B relapse after cessation of lamivudine or telbivudine treatment in chronic hepatitis B patients[J].Clin Microbiol Infect, 2015, 21 (12) :1123.e1-e9. [9] PAPATHEODORIDIS G, VLACHOGIANNAKOS I, CHOLONGITAS E, et al.Discontinuation of oral antivirals in chronic hepatitis B:A systematic review[J].Hepatology, 2016, 63 (5) :1481-1492. [10]FU HY, LIU P, MENG ZJ, et al.A clinical analysis of acute-on-chronic liver failure caused by reaction to withdrawal from nucleos (t) ide analogues[J].Chin J Integr Tradit West Med Liver Dis, 2017, 27 (5) :308-311. (in Chinese) 付洪彦, 刘平, 孟忠吉, 等.核苷 (酸) 类似物停药反跳致慢加急性肝衰竭的临床分析[J].中西医结合肝病杂志, 2017, 27 (5) :308-311. [11]LIU XY, CHEN J, XIAO L, et al.Clinical features of HBV-associated acute-on-chronic liver failure induced by discontinuation of nucleoside analogues[J].J Clin Hepatol, 2016, 32 (9) :1766-1769. (in Chinese) 刘晓燕, 陈婧, 肖珑, 等.停用核苷和核苷酸类药物诱发HBV相关慢加急性肝衰竭患者的临床特点分析[J].临床肝胆病杂志, 2016, 32 (9) :1766-1769. [12] OU SH, CHEN YP, JIANG RL, et al.Prognostic analysis of acute-on-chronic liver failure after withdrawal of nucleos (t) ide analogues for antiviral treatment of chronic hepatitis B[J].Chin J Hepatol, 2016, 24 (4) :252-257. (in Chinese) 区淑华, 陈永鹏, 姜荣龙, 等.核苷 (酸) 类药物治疗慢性乙型肝炎停药后复发相关肝衰竭预后分析[J].中华肝脏病杂志, 2016, 24 (4) :252-257. [13]KAMATH PS, KIM WR, Advanced Liver Disease Study Group.The model for end-stage liver disease (MELD) [J].Hepatology, 2007, 45 (3) :797-805. [14]LI H, XIA Q, ZENG B, et al.Submassive hepatic necrosis distinguishes HBV-associated acute on chronic liver failure from cirrhotic patients with acute decompensation[J].J Hepatol, 2015, 63 (1) :50-59. [15] LI H, CHEN LY, ZHANG NN, et al.Characteristics, diagnosis and prognosis of acute-on-chronic liver failure in cirrhosis associated to hepatitis B[J].Sci Rep, 2016, 6:25487. [16] TERRAULT NA, LOK AS, Mc MAHON BJ, et al.Update on prevention, diagnosis, and treatment and of chronic hepatitis B:AASLD 2018 hepatitis B guidance[J].Hepatology, 2018.[Epub ahead of print] 期刊类型引用(14)
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11. 李振华,解宝江,张丽菊,易为,伊诺. 乙型肝炎病毒表面抗原和e抗原双阳性乙型肝炎病毒高载量孕妇孕晚期应用替比夫定行母婴阻断的疗效. 中华实验和临床感染病杂志(电子版). 2019(03): 214-220 . 百度学术
12. 冯霞,刘贵章,赵登蕴,李声方. 血清IL-35在评估核苷(酸)类似物治疗慢性乙型肝炎中的临床应用. 肝脏. 2019(08): 915-917 . 百度学术
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其他类型引用(2)
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