Objective: To investigate the influence of ascites grading and non-selective β- blockers (NSBBs) on the 1-year prognosis of patients with acute-on-chronic liver failure (ACLF). Methods: A total of 1 386 patients with ACLF were graded for ascites and followed up for one year. Kaplan-Meier Log-rank test and Cox regression were used for multivariate regression to analyze the effects of ascites grading and NSBBs on the 1-year prognosis of ACLF. Results: The incidence of ascites in 1 836 patients with ACLF was 77.56% on admission. Ascites grade was related to the 1-year prognosis of ACLF [log rank (Mantel-Cox) χ2=21.384, p=0.000]. Cox stepwise regression analysis showed that ascites grade, age, gastrointestinal bleeding, pulmonary infection, acute kidney injury, prothrombin time activity(PTA), urea, MELD-Na score, and application of NSBBs were closely related to the 1-year prognosis of ACLF. The result of Kaplan-Meier Log-rank test for patients treated with NSBBs in the grade 2/3 ascites group suggest that NSBBs can improve the 1-year survival rate of ACLF patients with grade 2 and grade 3 ascites ( log rank (Mantel-Cox) χ2=6.113, p=0.013). Conclusions: Ascites grading and application of NSBBs can affect the 1-year prognosis of ACLF. NSBBs may be beneficial to the long-term prognosis of ACLF. Patients treated with NSBBs before the onset of ACLF should continue NSBBs treatment.
目的： 探讨腹水分级及非选择性β受体阻滞剂（NSBBs）应用对慢加急性肝衰竭（ACLF）1年预后的影响。 方法： 对1 386例ACLF患者进行腹水分级并随访1年，使用Kaplan-Meier Log-rank检验、Cox逐步回归法进行多因素回归，分析腹水分级及NSBBs等对ACLF 1年预后的影响。计量资料组间数据比较应用t检验、Mann-Whitney U或Kruskal-Wallis检验；数资料组间数据比较采用χ2检验。 结果： 1 386例ACLF患者入院时腹水发生率77.56%。1 386例ACLF患者腹水分级1年生存曲线检验结果log rank（Mantel-Cox）χ2=21.384，P<0.01。Cox逐步回归法进行多因素回归分析显示，腹水分级、年龄、消化道出血、肺部感染、急性肾损伤、凝血酶原活动度（PTA）、尿素、MELD-Na评分以及应用NSBBs与ACLF 1年预后密切相关。2级/3级腹水组NSBBs治疗log rank（Mantel-Cox）χ2=6.113，P=0.013，差异具有统计学意义。提示对有2级、3级腹水ACLF患者NSBBs治疗有助于提高ACLF 1年生存率。 结论： 腹水分级以及应用NSBBs等因素影响ACLF 1年预后；NSBBs对ACLF长期预后可能有益，ACLF发生前已经应用NSBBs的患者可以延续治疗。.