首次失代偿期乙型肝炎肝硬化患者获得再代偿的影响因素分析
DOI: 10.3969/j.issn.1001-5256.2022.08.015
Influencing factors for recompensation in patients with first-time decompensated hepatitis B cirrhosis
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摘要:
目的 分析实现再代偿的失代偿期乙型肝炎肝硬化患者的影响因素。 方法 纳入2011年9月1日—2019年12月31日就诊于徐州医科大学附属医院的初次失代偿乙型肝炎肝硬化患者438例,所有患者均接受包括抗病毒治疗在内的综合治疗。根据随访结束时患者的结局分为再代偿组和持续失代偿组,分析再代偿的独立影响因素。比较不同代偿状态的患者长期生存率方面的差异。计量资料两组间比较采用Mann-Whitney U检验;计数资料两组间比较采用χ2检验。采用多因素Cox风险比例回归模型分析再代偿的影响因素。采用Kaplan-Meier法绘制生存曲线,log-rank检验生存曲线。 结果 438例失代偿期乙型肝炎肝硬化患者经过抗病毒治疗后最终有199例实现再代偿(45.4%),与持续失代偿患者比较,持续病毒学应答(χ2=72.093,P<0.001)、单个或多个并发症(χ2=9.834,P=0.002)、是否消化道出血(χ2=6.346,P=0.012)、血清肌酐(Z=-1.035,P=0.011)、血钠浓度(Z=-1.606,P=0.019)、Hb(Z=1.455,P=0.006)及ALT水平(Z=-2.194,P<0.001)差异均有统计学意义。基线ALT水平(OR=1.002,95%CI:1.000~1.003,P=0.009),是否获得SVR(OR=5.760,95%CI:3.634~9.129,P<0.001)及血清肌酐(OR=0.990,95%CI:0.981~1.000,P=0.047)是再代偿的独立影响因素。再代偿患者的5年存活率显著高于持续失代偿患者(87.9% vs 72.0%,χ2=9.886, P=0.025)。 结论 经过抗病毒治疗等综合治疗后,大约有45.4%的患者可以实现再代偿。基线ALT升高及实现SVR的患者更容易实现再代偿,基线血清肌酐升高的患者难以实现再代偿,再代偿患者的长期预后较持续失代偿患者更好。 Abstract:Objective To investigate the influencing factors for recompensation in patients with first-time decompensated hepatitis B cirrhosis. Methods A total of 438 patients with first-time decompensated hepatitis B cirrhosis who attended The Affiliated Hospital of Xuzhou Medical University from September 1, 2011 to December 31, 2019 were enrolled, and all patients received comprehensive treatment including antiviral therapy. According to the outcome at the end of follow-up, the patients were divided into recompensation group and persistent decompensation group, and the independent influencing factors for recompensation were analyzed. Long-term survival rate was compared between the patients with different states of compensation. The Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data. A multivariate Cox proportional-hazards regression model analysis was used to investigate the influencing factors for recompensation. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used for comparison. Results Among the 438 patients with decompensated hepatitis B cirrhosis, 199 (45.4%) achieved recompensation after antiviral therapy. There were significant differences between the recompensation group and the persistent decompensation group in sustained virologic response (SVR) (χ2=72.093, P < 0.001), single or multiple complications (χ2=9.834, P=0.002), presence or absence of gastrointestinal bleeding (χ2=6.346, P=0.012), serum creatinine (SCr) (Z=-1.035, P=0.011), blood sodium concentration (Z=-1.606, P=0.019), hemoglobin (Z=1.455, P=0.006), and alanine aminotransferase (ALT) level (Z=-2.194, P < 0.001). Baseline ALT level (odds ratio [OR]=1.002, 95% confidence interval [CI]: 1.000-1.003, P=0.009), SVR (OR=5.760, 95%CI: 3.634-9.129, P < 0.001), and SCr (OR=0.990, 95%CI: 0.981-1.000, P=0.047) were independent influencing factors for recompensation. The recompensation group had a significantly higher 5-year survival rate than the persistent decompensation group (87.9% vs 72.0%, χ2=9.886, P=0.025). Conclusion After comprehensive treatment, including antiviral therapy, approximately 45.4% of patients can achieve recompensation.Patients with elevated baseline ALT and achieved SVR were more likely to achieve recompensation, patients with elevated baseline serum creatinine had difficulty achieving recompensation, and patients with recompensation had a better long-term prognosis than patients with persistent decompensation. -
Key words:
- Hepatitis B, Chronic /
- Liver Cirrhosis /
- Risk Factors
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表 1 再代偿患者与持续失代偿患者临床基线资料比较
Table 1. Clinical baseline data for recompensated patients and persistent decompensation patients
项目 再代偿组(n=199) 持续失代偿组(n=239) 统计值 P值 男/女(例) 127/72 155/84 χ2=0.005 0.941 年龄(岁) 50(44~59) 51(44~64) Z=4.797 0.101 随访时间(月) 23.0(15.0~45.0) 20.5(9.0~60.8) Z=-0.227 0.820 家族史[例(%)] 32(16.1) 41(17.2) χ2=0.009 0.764 SVR(例) 162/37 99/140 χ2=72.093 <0.001 首次失代偿事件 单个/多个并发症(例) 179/20 187/52 χ2=9.834 0.002 腹水[例(%)] 145(72.9) 155(64.9) χ2=3.299 0.072 消化道出血[例(%)] 34(17.1) 65(27.2) χ2=6.346 0.012 肝性脑病[例(%)] 13(6.5) 28(11.7) χ2=0.438 0.064 自发性腹膜炎[例(%)] 14(7.0) 23(9.6) χ2=0.941 0.332 Scr(μmol/L) 59(49~70) 62(51~76) Z=-1.035 0.011 INR 1.44(1.23~1.62) 1.46(1.23~1.64) Z=-0.545 0.461 Alb(g/L) 32.4(29.2~36.7) 31.7(27.7~36.4) Z=0.793 0.119 TBil(μmol/L) 32.5(21.0~60.7) 30.7(18.3~54.8) Z=-1.423 0.590 Na(mmol/L) 140.0(137.7~142.0) 139.0(136.6~141.6) Z=-1.606 0.019 WBC(×109/L) 3.6(2.7~5.0) 3.7(2.6~5.6) Z=-0.735 0.620 Hb(g/L) 116(99~133) 112(88~127) Z=1.455 0.006 NLR 2.06(1.36~3.53) 2.28(1.51~4.40) Z=-0.965 0.087 PLT(×109/L) 69(49~102) 64(46~96) Z=-0.312 0.332 ALT(U/L) 56(32~110) 41(23~70) Z=-2.194 <0.001 AFP(ng/mL) 11.30(3.49~71.84) 10.25(3.19~70.46) Z=-2.032 0.243 MELD评分 10.42(6.66~14.29) 10.77(7.18~15.50) Z=0.384 0.251 CTP评分 7(6~9) 7(6~9) Z=-0.085 0.160 CTP分级[例(%)] χ2=4.297 0.117 A级 83(41.7) 77(32.2) B级 74(37.2) 106(44.4) C级 42(21.1) 56(23.4) 注:Scr,血清肌酐;NLR, 中性粒细胞与淋巴细胞比值。 表 2 再代偿相关影响因素的多因素分析
Table 2. Multivariate analysis of the influencing factors related to recompensation
自变量 β值 SE Wald OR 95%CI P值 ALT 0.002 0.001 6.802 1.002 1.000~1.003 0.009 单个并发症 -0.412 0.354 1.358 0.662 0.331~1.324 0.244 SVR 1.751 0.235 55.516 5.760 3.634~9.129 <0.001 Scr -0.010 0.005 3.955 0.990 0.981~1.000 0.047 Hb 0.004 0.004 1.065 1.004 0.996~1.012 0.302 -
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