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目的 探讨核苷(酸)类似物治疗慢性乙型肝炎停药后复发相关性慢加急性肝衰竭的预后影响因素. 方法 将核苷(酸)类药物治疗慢性乙型肝炎停药后复发相关肝衰竭住院患者根据12周生存情况分为生存组和死亡组.收集患者入院时的临床信息和指标:初始抗HBV治疗的药物及疗程、停药至发病时间、感染、肝性脑病、肝硬化、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素、白蛋白、血清肌酐、国际标准化比值、白细胞、血小板、HBV DNA、HBeAg、甲胎蛋白等,根据临床指标计算CTP评分、终末期肝病模型(MELD)评分、MELD-Na评分,分析上述指标与患者肝衰竭12周死亡相关性,确定预测值. 结果 初治前和复发后HBeAg状态、抗病毒疗程、停药至复发时间及停药前后核苷(酸)类似物种类均与预后无关.Cox单因素回归分析结果显示胆红素、国际标准化比值、肌酐、终末期肝病模型评分、肝性脑病及合并感染与患者12周死亡相关.Cox多因素回归分析表明终末期肝病模型评分及肝性脑病是患者12周死亡的独立预测指标.入院时终末期肝病模型评分值预测12周死亡的受试者工作特征曲线下面积为0.906,最佳临界值为32,灵敏度为82.9％,特异度为88.5％,阳性预测值为91.9％,阴性预测值为76.7％.结论 终末期肝病模型评分及肝性脑病与核苷(酸)类似物停药相关性慢加急性肝衰竭患者预后密切相关.“,”Objective To investigate the prognostic factors for acute-on-chronic liver failure (ACLF) after the withdrawal of nucleos(t)ide analogues (NAs) for the antiviral treatment of chronic hepatitis B (CHB).Methods The clinical data of 67 hospitalized patients with ACLF after withdrawal of NAs for the antiviral treatment of CHB were analyzed retrospectively.Results The HBeAg status before initial treatment and after recurrence,course of the antiviral treatment,duration from the withdrawal of NAs to recurrence,and type of NAs before and after withdrawal were not associated with the prognosis of ACLF.The Cox univariate regression analysis showed that serum bilirubin,international normalization ratio,serum creatinine,model of end-stage of liver disease (MELD) score,hepatic encephalopathy,and concurrent infection were associated with the 12-week death.The Cox multivariate regression analysis showed that MELD score and hepatic encephalopathy were independent predictors for 12-week death.The area under the receiver operating characteristic curve for the MELD score to predict 12-week death was 0.906,with an optimal cutoff value of 32,a sensitivity of 82.9％,a specificity of 88.5％,a positive predictive value of 91.9％,and a negative predictive value of 76.7％.Conclusion MELD score and hepatic encephalopathy are closely associated with the prognosis of patients with ACLF after withdrawal of NAs for the antiviral treatment of CHB.