■由于肝硬化是一种动态状态,有可能提高失代偿期肝硬化的生存率。因此,我们计划进行一项前瞻性研究,以确定首次失代偿后肝硬化的自然史.
■我们招募了所有肝硬化患者,这些患者首次出现由腹水定义的代偿失调,公开或通过超声检查(UD)检测到,胃食管静脉曲张出血(GEVB),肝性脑病(HE)。所有患者均随访至死亡/肝移植或至少1年。使用多变量Cox比例风险回归分析失败的风险(死亡或原位肝移植(OLT))。
■总共110例肝硬化患者(93例男性,平均年龄50±11岁),最常见的病因是酒精(48%),其次是非酒精性脂肪性肝炎/隐源性(26%),乙型肝炎(10%),自身免疫性肝炎(7%),丙型肝炎(6%)。CTP类的分布为:4%,56%,A类占41%,B,C,分别。腹水是88例(80%)患者中最常见的代偿失调,其次是HE(14%)和GEVB(6%)。在1年的随访中,无移植生存率为78%,2个接受了OLT,4发达的肝细胞癌,24人死亡1年后代偿失调类型的失败(死亡或OLT)的累积发生率为:22%明显的腹水,50%GEVB,28%UD腹水,20%HE,和33%的腹水和GEVB伴随。
■与明显的腹水相比,UD腹水患者的死亡率可忽略不计。首次失代偿后的肝硬化患者在病因和并发症的治疗下具有比文献中先前提到的更好的无移植生存率。
UNASSIGNED: As liver cirrhosis is a dynamic condition, it is possible to improve survival in decompensated cirrhosis. Hence, we planned a prospective study to determine the natural history of cirrhosis after first decompensation.
UNASSIGNED: We enrolled all patients of liver cirrhosis who presented with first episode of decompensation defined by the presence of ascites, either overt or detected by Ultrasonography (UD), Gastroesophageal Variceal Bleeding (GEVB), and Hepatic Encephalopathy (HE). All patients were followed up to death/liver transplant or at least for the period of 1 year. Multivariable Cox proportional hazards regression was used to analyze the risk of failure (death or Orthotopic Liver Transplantation (OLT)).
UNASSIGNED: In total of 110 cirrhotic patients (93 males, mean age 50 ± 11 years), the most frequent etiology was alcohol (48%), followed by nonalcoholic steatohepatitis/cryptogenic (26%), hepatitis B (10%), autoimmune hepatitis (7%), and hepatitis C (6%). The distribution of CTP classes was: 4%, 56%, and 41% in class A, B, and C, respectively. Ascites was the most common decompensation found in 88 patients (80%) followed by HE (14%) and GEVB (6%). At 1-year follow up, transplant free survival was 78%, 2 underwent OLT, 4 developed hepatocellular carcinoma, and 24 died. Cumulative incidence of failure (death or OLT) by type of decompensation after 1 year was: 22% overt ascites, 50% GEVB, 28% UD ascites, 20% HE, and 33% ascites and GEVB concomitant.
UNASSIGNED: Patients with UD ascites do not have a negligible mortality rate as compared to overt ascites. Patients with cirrhosis after first decompensation have better transplant free survival with treatment of etiology and complications than previously mentioned in literature.