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目的分析丙型肝炎病毒(hepatitis C virus,HCV)相关慢加急性肝衰竭(HCV-ACLF)患者临床特点,为指导HCV-ACLF治疗提供依据。方法回顾性分析146例HCV-ACLF患者年龄、肝功能指标、转归等临床特点。结果根据是否重叠乙型肝炎病毒(hepatitis B virus,HBV)感染分为单纯HCV-ACLF组(114例)和重叠HCV-ACLF组(32例),单纯HCV-ACLF组和重叠HCV-ACLF组患者年龄分别为(57.45±12.60)岁及(48.06±10.54)岁,两组之间比较差异有统计学意义(P<0.01)。单纯HCVACLF组中的老年患者(>60岁)比率明显高于重叠HCV-ACLF组(P<0.01)。单纯HCV-ACLF组及重叠HCV-ACLF组患者的胆碱酯酶(CHE)、总胆红素(TBIL)、凝血酶原活动度(PTA)、白蛋白(ALB)、甲胎蛋白(AFP)水平比较差异均无统计学意义,而丙氨酸氨基转移酶(ALT)指标差异有统计学意义(P<0.05)。单纯HCV-ACLF比重叠HCV-ACLF患者好转率低(P<0.05)。单纯HCV-ACLF组腹水、电解质代谢异常、感染、糖尿病、肝硬化的发病率均明显高于重叠HCV-ACLF组(P<0.05),而肝性脑病、上消化道出血、伴发肿瘤、胸水在单纯HCV-ACLF组中发生率虽然比HBV重叠HCV-ACLF组高,但是两组比较差异无统计学意义(P>0.05)。结论单纯HCV-ACLF组比重叠HCV-ACLF患者年龄大,并发症发生率高,好转率低,两组患者发病机制可能存在差异。
Objective To analyze the clinical features of hepatitis C virus (HCV) -related slow-acting acute liver failure (HCV-ACLF) patients and provide the basis for guiding the treatment of HCV-ACLF. Methods A retrospective analysis of 146 cases of HCV-ACLF patients with age, liver function, outcome and other clinical features. Results According to whether hepatitis B virus (HBV) infection was divided into simple HCV-ACLF group (114 cases) and overlapping HCV-ACLF group (32 cases), HCV-ACLF group and overlapping HCV-ACLF group (57.45 ± 12.60) years old and (48.06 ± 10.54) years old, respectively. There was significant difference between the two groups (P <0.01). The proportion of elderly patients (> 60 years) in the HCVACLF-only group was significantly higher than in the overlapping HCV-ACLF group (P <0.01). Cholinesterase (CHE), total bilirubin (TBIL), prothrombin activity (PTA), albumin (ALB), AFP in patients with HCV-ACLF and HCV- (P <0.05). There was no significant difference in the levels of ALT between the two groups (P <0.05). The improvement rate of patients with HCV-ACLF over HCV-ACLF was lower (P <0.05). The incidence of ascites, abnormal electrolyte metabolism, infection, diabetes and cirrhosis in HCV-ACLF group was significantly higher than that in overlapping HCV-ACLF group (P <0.05), while hepatic encephalopathy, upper gastrointestinal bleeding, Although the incidence of HCV-ACLF group was higher than that of HCV-ACLF group, there was no significant difference between the two groups (P> 0.05). Conclusions Compared with HCV-ACLF patients in HCV-ACLF group, the HCV-ACLF patients were older, the incidence of complications was higher, the rate of improvement was lower, and the pathogenesis of HCV-ACLF in both groups may be different.