摘要
目的:探讨湿性体质对乙型肝炎慢加急性肝衰竭患者短期预后的影响.方法:选择2009年1月至2019年12月在中国人民解放军东部战区总医院就诊的乙型肝炎慢加急性肝衰竭(HBV-ACLF)患者作为研究对象,收集其入院时的中医体质类型(痰湿质及湿热质归为湿性体质类型),以及实验室指标.根据随访终点患者的生存状态,将研究对象分为生存组和死亡组.采用Kaplan-Meier曲线分析湿性体质及其他类型体质患者30 d及60 d的累积生存率,采用多元Cox回归模型分析湿性体质及肝衰竭分期、并发症等风险因素对HBV-ACLF患者30 d及60 d生存情况的影响.结果:共纳入分析400例HBV-ACLF患者,其中生存组318例,死亡组82例.与生存组比较,死亡组患者在年龄、总胆红素、白细胞计数、谷丙转氨酶、谷草转氨酶、肌酐、血氨、空腹血糖、乙肝病毒DNA、凝血酶原活动度、乙肝e抗原阳性率及体质类型等方面,具有统计学差异(P<0.05).以“其他体质”类型作为参照,多元Cox回归模型结果显示,30 d死亡风险因素中,湿性体质HR=1.58(95%CI[0.73,3.38],P=0.244),提示湿性体质与30 d死亡风险无显著相关性.60 d死亡风险因素中,湿性体质HR=1.97(95%CI[1.11,3.52],P=0.021),提示湿性体质与60 d死亡具有显著相关性.结论:湿性体质可能是乙型肝炎慢加急性肝衰竭患者短期预后的独立危险因素.
Objective:To explore the influence of damp traditional Chinese medicine(TCM)constitution on the short-term prognosis of patients with hepatitis B-acute-on-chronic liver failure(HBV-ACLF).Methods:Patients with HBV-ACLF who were diagnosed and treated in General Hospital of Eastern Theater Command of the Chinese People's Liberation Army were included in the study from January 2009 to December 2019.The data collection included TCM constitution type(the damp-heat and phlegm-wet TCM constitution were classified as damp TCM constitution)and laboratory indexes of all patients at admission.The primary end point was 30 d and 60 d mortality.According to the survival status of patients at the end of follow-up,patients were divided into survival group and dead group.Kaplan Meier curve was used to analyze the 30 d and 60 d cumulative survival rate of patients with different TCM constitution.Multivariate Cox regression model was used to analyze the influence of risk factors such as damp TCM constitution,stages of liver failure and complications on the 30 d and 60 d prognosis of patients with HBV-ACLF.Results:A total of 400 patients with HBV-ACLF were included in the analysis,including 318 in the survival group and 82 in the dead group.Compared with the survival group,there were significant differences in age,total bilirubin,alanine aminotransferase,aspartate aminotransferase,creatinine,blood ammonia,fasting blood glucose,HBV DNA,PTA,HBeAg and TCM constitution type in the dead group(all P<0.05).The results of multivariate Cox regression model showed that the mortality risk of damp TCM constitution was 1.58(95%CI[0.73,3.38],P=0.244),which indicated that there was no significant correlation between the mortality risk in 30 d and damp TCM constitution.The results of 60 d mortality risk showed that HR of damp TCM constitution was 1.97(95%CI[1.11,3.52],P=0.021),indicating that there was a significant correlation between Damp TCM constitution and 60 days mortality.Conclusion:Damp TCM constitution was an independent risk factor for short-term prognosis in patients with HBV-ACLF.
作者
谢芳
范晔
郑文凯
汪茂荣
XIE Fang;FAN Ye;ZHENG Wenkai;WANG Maorong(Liver Diseases Center, General Hospital of Eastern Theater Command of the Chinese People’s Liberation Army, Nanjing 210000, China)
出处
《暨南大学学报（自然科学与医学版）》
CAS
CSCD
北大核心
2020年第4期343-350,共8页
Journal of Jinan University(Natural Science & Medicine Edition)
基金
军队医学创新工程项目(16CXZ045)。
关键词
中医体质
乙型病毒性肝炎
慢加急性肝衰竭
traditional Chinese medicine constitution
hepatitis B virus
acute-on-chronic liver failure
作者简介
谢芳(1982-),女,研究方向:各种急慢性肝病的中西医临床研究,E-mail:rosemary1223@126.com;通讯作者:汪茂荣,博士,主任医师,研究方向:急慢性肝病的治疗,E-mail:maorongwang@126.com。
