季淑静，王梦洁，陈金军

·肝衰竭·

慢加急性乙型肝炎肝衰竭患者贫血特点分析*

季淑静，王梦洁，陈金军

目的探索慢加急性肝衰竭患者贫血的发生、转归及对短期生存的影响。方法纳入2011年12月至2013年1月我院住院的乙型肝炎病毒感染导致的慢加急性肝衰竭患者，中心实验室常规检测血常规、血肌酐、谷丙转氨酶、谷草转氨酶、白蛋白、总胆红素、凝血功能指标等。与慢性乙型肝炎及HBV相关的肝硬化患者比较，观察慢加急性肝衰竭患者贫血的发生、转归。结果在纳入的171例肝病患者中，40例慢性乙型肝炎患者贫血发生率为2.5%，49例肝硬化患者为34.7%，82例慢加急性肝衰竭患者住院时贫血发生率为45.1%（其中26.8%为轻度贫血，17.1%为中度贫血，1.2%为重度贫血）；慢加急性肝衰竭患者贫血程度在住院1周内加重（122.4 g/L对112.7 g/L，P<0.001）；长期生存患者（n=42）恢复期贫血情况显著改善(147.5 g/L对入院时的112.7 g/L，P=0.001)；住院首日血红蛋白水平（截断点125.5 g/L）是90天生存率的预测因素（曲线下面积=0.735，P＜0.001）。结论慢加急性肝衰竭患者贫血发生率高，对短期生存不利，而生存者贫血情况可缓慢恢复；入院时血红蛋白水平能预测短期预后。

慢加急性肝衰竭；乙型肝炎；贫血；短期生存

【Abstract】ObjectiveTo investigate the prevalence of anemia in patients with hepatitis B virus-induced acute-on-chronic liverfailure（ACLF），and to evaluateitsassociationwith short-termsurvivals.Methods Hospitalized patients with HBV related acute-on-chronic liver failure，cirrhosis or chronic hepatitis B were recruited from December 2011 to January 2013 in this study.The peripheral blood index were routinely assayed. The prevalence and progression of anemia and clinical outcome of patients were observed.ResultsThere were 171 patients included in this study.2.5%out of 40 patients with chronic hepatitis B，34.7%out of 49 patients with liver cirrhosis and 45.1%out of 72 patients with ACLF had anemia at admission；and the percentages of mild，moderate and severe anemia in patients with ACLF were 26.8%，17.1%and 1.2%，respectively；Anemia in patients with ACLF exacerbated within first hospitalization week（122.4g/L vs.112.7g/L，P=0.001）；the blood hemoglobin levels in survived patients with ACLF（n=42）increased（112.7 g/L vs.147.5 g/L，P=0.001）；Blood hemoglobin levels in patients with ACLF at admission（cut-off value was 125.5 g/L）was an predictor for 90-day survivals（AUROC=0.735，P<0.001）.ConclusionsAnemia in patients with ACLF is common and severe，which might aggravate within one week and recover in survivals.

【Key words】Acute-on-chronic liver failure；Anemia；Hepatitis B；Short-term survival

在临床实践中，我们发现慢性肝病患者常伴贫血，尤其是慢加急性肝衰竭（Acute on chronic liver failure，ACLF）患者。但国内外ACLF患者贫血方面的相关研究甚少。本研究观察了HBV感染不同疾病谱和不同病程阶段患者贫血发生情况及其相关影响因素。

1　资料与方法

1.1病例来源纳入2011年12月～2013年1月在我院感染内科住院的慢性乙型肝炎（CHB）、肝硬化（LC）、HBV相关ACLF患者。入选标准：诊断分别符合慢性乙型肝炎防治指南[1]、肝硬化[2]、肝衰竭诊疗指南[3]。排除标准：原发性肝癌或接受肝移植患者、合并血液系统肿瘤、骨髓抑制、使用明确的骨髓抑制药物、入院前至住院1周后有明确的出血者和输血者。其中肝硬化病因排除了酒精、药物、自身免疫性和肝豆状核变性等原因；……