Clinical features and prognosis of decompensated hepatitis C virus related cirrhosis

目的 分析慢性丙型肝炎肝硬化患者第1次出现并发症后的临床特点及预后.方法 对89例失代偿性丙肝肝硬化患者进行5年的随访观察,并对临床失代偿发生因素进行单因素和多因素分析.结果 第1次出现并发症时,腹水最常出现占40例(44.9%),其次上消化道出血21例(23.6%),自发性腹膜炎18例(20.2%),肝性脑病10例(11.2%).在平均62个月(60～66个月)随访过程中,42例患者出现腹水(47.2%),16例出现自发性腹膜炎(18.0%),14例上消化道出血(15.7%),7例肝性脑病(7.9%),10例肝癌(11.2%).肝癌是患者的主要死亡原因(11.2%),每年的病死率4.5%.肝性脑病、腹水、消化道出血、自发性腹膜炎为第1个失代偿期并发症者5年的生存率分别为64.5%、85.0%、75.0%、83.3%,多因素回归分析结果显示食管胃底静脉曲张和胆红素为临床失代偿发生的惟一独立预测因素.结论 慢性丙型肝炎肝硬化是一个缓慢进行性疾病,肝癌是其重要并发症,并发症的出现对预后有影响,这些结果将有利于探讨失代偿期丙肝肝硬化患者的自然病程和临床预后.Objectlve To study the clinical features and prognosis of hepatitis C virus (HCV)-related cirrhosis after the first occurrence of complications.Methods The clinical data of 89 decompensated HCV-related cirrhosis patients were analyzed.Univariate and multivariate analyses of the factors influencing the clinical decompensation were conducted.Results Ascites was the most frequent first decompensation (44.9％),followed by upper gastrointestinal bleeding (23.6％),and serf-originated peritonitis (20.2％),and hepatic encephalopathy (11.2％).During the follow-up of 62 months (60-66 months) ascites was the most frequent first decompensation (47.2％),followed by self-originated peritonitis (18.0％),upper gastrointestinal bleeding(15.7％),and hepatic encephalopathy(7.9％).The 5-year survival rates after of the patients with hepatic encephalopathy,ascites,upper gastrointestinal bleeding and self-originated peritonitis as the first decompensated complications were 64.5％,85.0％,75.0％,and 83.3％ respectively.Multivariate regression analysis showed that esophageal and gastro varices and billirubin were independently correlated with survival.Conclusion Hepatitis C iS a slowly progressing disease.Decompensation occurring in hepatitis C is significantly correlated with survival.国家科技攻关项目PubMed中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)08516-5198