| Objective:To investigate the inducements and prognostic factors of hepatitis B virus related acute-on-chronic liver failure(HBV-ACLF),deepen the understanding of its pathogenesis and improve the diagnosis and treatment.Methods:Information on 314 patients with hepatitis B virus related acute-on-chronic liver failure who were admitted to the First Hospital of Jilin University from September 11,2012 to September 1,2018 were collected,including gender,age,and inducement of illness,complications,and laboratory tests:white blood cells(WBC),red blood cells(RBC),hemoglobin(Hb),platelets(PLT),aspartate aminotransferase(AST),alanine aminotransferase(ALT),gamma-glutamyltranspeptidase(γ-GT),alkaline phosphatase(ALP),total bilirubin(TBil),Albumin(Alb),prothrombin time(PT),activated partial thromboplastin time(APTT),prothrombin activity(PTA),international normalized ratio(INR),fibrinogen(FBG),serum creatinine(SCr),urea nitrogen(BUN),Na~+,K~+,Cl~-,Ca~+,alpha-fetoprotein(AFP),e antigen(HBeAg),e antibody(HBeAb),core antibody(HBcAb),hepatitis B virus nucleic acid load(HBV DNA),and CTP score.The above indicators are retrospectively analyzed.Results:1.Of the 314 patients with HBV-ACLF,263(83.76%)were male and 51(16.24%)were female.There were 30 patients(9.55%)in the improved group,82patients(26.12%)in the improving trend group,85 patients(27.07%)in the unchanged group,85 patients(27.07%)in the deterioration group,and 32 patients(10.19%)in the death/liver transplantation group.2.Of the 314 patients with HBV-ACLF,80(25.48%)were alcoholics,76(24.20%)overworked,52(16.56%)were treated with other drugs,and 36(11.46%)with unknown causes.31 cases(9.87%)discontinued antiviral drugs,17 cases(5.41%)had infection,10 cases(3.18%)had virus mutation,4 cases(1.27%)had other hepadnavirus infections,3 cases used immunosuppressive agents(0.96%),1case(0.32%)used antiviral drugs irregularly.There was no significant difference in the composition ratio of each group(P>0.05).3.The improvement rate of male patients(7.22%)was lower than that of female patients(21.57%),and the deterioration rate(28.90%)was higher than that of female patients(17.65%).The difference was statistically significant(P<0.05).4.There was a significant difference in the incidence of hepatic encephalopathy and gastrointestinal bleeding between the five groups.The incidence of hepatic encephalopathy in the unchanged group,the deterioration group,and the death/liver transplantation group was significantly higher than that in the improved group and the improving trend group(P<0.05).The incidence of gastrointestinal hemorrhage in the death/liver transplantation group was significantly higher than that in the improving trend group and unchanged group,and the difference was statistically significant(P<0.05).5.The number of complications in the unchanged group and the deterioration group was larger than that in the improved group and the improving trend group,the death/liver transplantation group larger than the improved group,the improving trend group,and the unchanged group,and the differences were statistically significant(P<0.05).6.The CTP score did not differ significantly between groups.The MELD score of the improving trend group,the unchanged group,and the deterioration group were significantly higher than that of the improved group,and the MELD score of death/liver transplantation group was significantly higher than that of the improved group,the improving trend group,and the unchanged group,and the differences were statistically significant(P<0.05).The MELD-Na score of the improving trend group,the unchanged group,the deterioration group,and the death/liver transplantation group were significantly higher than the improved group,and the differences were statistically significant(P<0.05).2.The unhealed/death group was more likely to have hepatic encephalopathy than the improved group,with statistically significant differences(P<0.05),and there were no significant differences between the two groups in other complications.3.Logistic regression analysed the factors affecting the prognosis of HBV-ACLF,PLT,Alb were protective factors for the prognosis of the disease,whileγ-GT was a risk factor for the prognosis of the disease.Conclusion:1.In HBV-ACLF patients,men are more likely than women to have poor prognosis.2.Monitoring of Alb in liver function and PLT in blood routine in patients with HBV-ACLF has a suggestive effect on the prognosis of the disease:the lower Alb and PLT,the worse the prognosis.3.The greater the number of complications in patients with HBV-ACLF is,the worse the prognosis become.4.The MELD score and the MELD-Na score were superior to the CTP score in evaluating the prognosis of patients with HBV-ACLF. |
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