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| 停用核苷（酸）类药物后诱发HBV相关慢加急性肝衰竭的临床特征及远期预后分析 |
| Clinical features and long-term prognosis of HBV-related acute-on-chronic liver failure induced by discontinuation of nucleos(t)ide analogues |
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| DOI：10.3969/j.issn.1007-8134.2021.03.006 |
| 中文关键词: 慢性乙型肝炎 核苷（酸）类药物 诱发 慢加急性肝衰竭 预后 |
| 英文关键词: chronic hepatitis B nucleos(t)ide analogues induction acute-on-chronic liver failure prognosis |
| 基金项目:“十三五”国家科技重大专项（2018ZX10725506-002） |
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| 中文摘要: |
| 目的 探究慢性乙型肝炎（chronic hepatitis B, CHB）患者停用核苷(酸）类药物[nucleos(t)ide analogues, NAs]后诱发HBV相关慢加急性肝衰竭（HBV related acute-on-chronic liver failure, HBV-ACLF）的临床特征及远期预后情况。方法 纳入2014年6月—2019年6月我中心收治的所有HBV-ACLF患者共1164例，根据是否停用NAs分为停药组（n=187）和非停药组（n=977）。对患者进行随访，观察其临床特征，分析停药时间与ACLF发生的相关性和远期总体生存率。结果 停药组患者的HBeAg阳性率、HBV DNA载量明显高于非停药组，ALB和PLT水平低于非停药组（P均＜0.05）；在肝病相关临床事件中，停药组患者的脓毒症和肺部感染发生率均高于非停药组（P均＜0.05）；停药组患者的中位停药时间为6.0（2.0，20.6）个月。相关性分析结果显示，ACLF的分期与停药时间无显著相关性（r=0.083，P=0.257）；停药组30 d及90 d的总体生存率均显著低于非停药组（P均＜0.05）；360 d时，2组患者的总体生存率差异无统计学意义（P＞0.05）。结论 患者因停药后诱发HBV-ACLF，其HBeAg阳性率、HBV DNA载量和脓毒症发生率显著上升；停药会影响HBV-ACLF患者的近期生存率，且停药组患者短期病死率更高，但停药时间与患者病情严重程度无明显相关。 |
| 英文摘要: |
| Objective To explore the clinical features and long-term prognosis of HBV-related acute-on-chronic liver failure (HBV-ACLF) in patients with chronic hepatitis B (CHB) induced by discontinuation of nucleos(t)ide analogues (NAs). Methods A total of 1,164 patients with HBV-ACLF who were admitted to our hospital from June 2014 to June 2019 were included in this study, and they were divided into drug withdrawal group (n=187) and non-drug withdrawal group (n=977) according to the use/discontinuation of NAs. The patients were followed up and their clinical features were observed. The correlation between the drug withdrawal time and ACLF, and the long-term overall survival rate were analyzed. Results The HBeAg positive rate and HBV DNA load of the drug withdrawal group were significantly higher, while ALB and PLT levels were lower than those of the non-drug withdrawal group (P＜0.05). For clinical events related to liver disease, the incidences of sepsis and pulmonary infection were higher in the drug withdrawal group than those in the non-drug withdrawal group (P＜0.05). The median drug withdrawal time of the drug withdrawal group was 6.0 (2.0, 20.6) months. The correlation analysis showed that there was no significant correlation between the classification of ACLF and the withdrawal time (r=0.083, P=0.257). The overall survival rates of the drug withdrawal group on 30 d and 90 d were significantly lower than those of the non-drug withdrawal group (P＜0.05). On 360 d, there was no significant difference in overall survival rate between 2 groups (P＞0.05). Conclusions As HBV-ACLF is triggered after drug withdrawal, the HBeAg positive is rate, HBV DNA load and the incidence of sepsis in patients with ACLF increase significantly. Drug withdrawal will affect the patient’s short-term survival rate. The short-term mortality of patients with ACLF in the drug withdrawal group is higher, but there is no significant correlation between the length of drug withdrawal and the severity of the disease. |
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