本文選題：乙肝 + 慢加急性肝衰竭　； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：研究背景及目的:慢加急性肝衰竭(Acute-on-chronic liver failure,ACLF)概念已被國際廣泛接受,但在以慢性乙型肝炎(Chronic hepatitis B,CHB)為常見病因的亞太地區(qū),肝硬化是否應(yīng)該作為ACLF診斷的關(guān)鍵指標(biāo)爭議頗大。本研究旨在通過多中心、大樣本、前瞻性分析研究,系統(tǒng)闡明乙肝相關(guān)性慢加急性肝衰竭(HBV-related acute-on-chronic liver failure,HBV-ACLF)患者的特異性臨床特征,并建立新的HBV-ACLF診斷標(biāo)準(zhǔn)與預(yù)后評價體系。研究方法采用多中心、前瞻性臨床研究設(shè)計(jì),全國13個中心統(tǒng)一收集入組患者,入組標(biāo)準(zhǔn)為乙肝肝硬化患者出現(xiàn)急性失代償和慢乙肝患者出現(xiàn)急性嚴(yán)重肝損傷(總膽紅素[total bilirubin,TB]≥ 5md/dL,合并國際標(biāo)準(zhǔn)化比值[internationalnormalized ratio,INR]≥ 1.5)。采集患者所有臨床數(shù)據(jù)、預(yù)后指標(biāo),并結(jié)合血清巨噬細(xì)胞炎性蛋白-3α(serum macrophage inflammatory protein3α,MIP-3α),在此基礎(chǔ)上建立HBV-ACLF診斷標(biāo)準(zhǔn)與預(yù)后模型,并重新入組符合新建HBV-ACLF診斷標(biāo)準(zhǔn)的患者,設(shè)立外部驗(yàn)證組以驗(yàn)證新建預(yù)后模型的預(yù)后價值。研究結(jié)果:自2013年6月至2016年10月,13個中心共入組患者2638例,排除相關(guān)病例后共計(jì)1322例患者進(jìn)入研究分析,包括1031例乙肝相關(guān)性肝硬化急性失代償(patients who have an HBV infection with acute decompensation of cirrhosis,HBV-AD-C)、171例慢乙肝基礎(chǔ)上出現(xiàn)急性嚴(yán)重肝損(Patients who have an HBV infection with acute severe liver injury,HBV-ASI-NC)和 120 例非乙肝肝硬化急性失代償(ACLF with cirrhosis caused by non-HBV pathogens,NonHBV-AD-C)患者。結(jié)合EASL-ACLF 診斷標(biāo)準(zhǔn),HBV-AD-C、HBV-ASI-NC 和 NonHBV-AD-C 組分別有 271、92和28例被判斷為ACLF,并分別定義為乙肝肝硬化ACLF(HBV-ACLF-C)、慢乙肝基礎(chǔ)上ACLF(HBC-ACLF-NC)和非乙肝肝硬化ACLF(NonHBV-ACLF-C)。分析發(fā)現(xiàn)HBV-ACLF-C和HBV-ACLF-NC組短期(28天和90天)死亡率均顯著高于NonHBV-ACLF-C組。在器官衰竭分布上,HBV-ACLF以肝功能和凝血功能衰竭為主。通過對1119例(83例接受肝移植術(shù)除外)乙肝患者的進(jìn)一步研究發(fā)現(xiàn),單一肝功能衰竭合并INR≥ 1.5應(yīng)被納入HBV-ACLF的診斷標(biāo)準(zhǔn)。新的HBV-ACLF定義能夠有效地區(qū)分出高死亡率群體,并使19.3%的乙肝患者在入院時也被擴(kuò)大診斷為HBV-ACLF。在此基礎(chǔ)上建立的HBV-ACLF新預(yù)后模型也優(yōu)于CLIF-C ACLFs及其它預(yù)后評分,這在實(shí)驗(yàn)組以及154例外部驗(yàn)證組ACLF患者中都得到驗(yàn)證。此外,MIP-3α血清學(xué)分析顯示HBV-ACLF-C和HBV-ACLF-NC具有相似的生物學(xué)特性。結(jié)論:無論是否存在肝硬化,單一肝功能衰竭合并INR≥ 1.5的慢乙患者應(yīng)該被診斷為HBV-ACLF。新的診斷標(biāo)準(zhǔn)不僅完善了 EASL-ACLF對于HBV-ACLF的診斷局限性,更使得約20%的慢乙肝患者在入院時就被診斷為ACLF并得到及時的診治。
[Abstract]:Background and objective: the concept of Acute-on-chronic liver failure (ACLF) has been widely accepted in the world. However, in the Asia-Pacific region where chronic hepatitis B hepatitis (Chronic hepatitis) is a common cause, whether cirrhosis should be regarded as the key index for the diagnosis of ACLF is controversial. The purpose of this study was to systematically elucidate the specific clinical features of HBV-related acute-on-chronic liver failure in patients with chronic hepatitis B associated with acute liver failure by multi-center, large sample and prospective analysis, and to establish a new diagnostic criteria for HBV-ACLF and a prognostic evaluation system. Methods Multi-center, prospective clinical study design was used to collect patients in 13 centers in China. The admission criteria were acute decompensation in patients with hepatitis B cirrhosis and acute severe liver injury in patients with chronic hepatitis B (total bilirubin TB 鈮，

本文編號：1857643