乙型肝炎肝衰竭预后的影响因素  

Risk factors of prognosis for hepatitis B virus-related liver failure

作　　者：蒋孝华[1] 蔡亚平[2] 刘玲玲[1] 雷创[1] 李小芬[1] 周清平[1] 

机构地区：[1]南华大学附属第一医院感染科,湖南衡阳421001 [2]南华大学流行病学教研室,湖南衡阳421001

出　　处：《中国现代医学杂志》2010年第6期900-902,共3页China Journal of Modern Medicine

摘　　要：目的探讨影响乙型肝炎肝衰竭预后的因素。方法回顾性分析106例乙型肝炎肝衰竭患者的临床资料,应用Logistic回归分析筛选影响预后的独立危险因素。结果在106例乙型肝炎肝衰竭患者中,急性肝衰竭2例(1.9%),亚急性肝衰竭2例(1.9%),慢加急性肝衰竭102例(96.2%);HBeAg阳性37例(34.9%),HBeAg阴性69例(65.1%),入院后抗病毒治疗46例(43.4%);好转55例(51.9%),无效51例(48.1%)。单因素Logistic回归分析显示,肝病基础状态、总胆红素(TBil)、直接胆红素(DBil)、白蛋白(ALB)、血清钠离子(Na+)、血清氯离子(Cl-)、凝血酶原时间(PT)、并发细菌感染、肝性脑病、电解质紊乱、肝肾综合征和入院后是否抗病毒治疗,均与乙肝肝衰竭患者预后相关(P<0.05);多因素Logistic回归分析显示,肝病基础状态、凝血酶原时间及入院后是否抗病毒治疗和预后相关(P<0.05))。结论肝病基础状态和凝血酶原时间是影响乙肝肝衰竭患者预后的独立危险因素,抗病毒治疗有利于改善乙肝肝衰竭患者的预后。【Objective】 To explore independent risk factors of prognosis for hepatitis B virus-related liver failure.【Methods】Clinical data from 106 patients with HBV-related liver failure were retrospectively analyzed.Logis-tic regression analysis was performed for selecting the independent risk factors influencing the prognosis.【Results】 Of all the 106 patients with HBV-related liver failure,2（1.9%） patients had acute liver failure,2（1.9%） had subacute liver failure,and the remaining 102（96.2%） had acute-on-chronic liver failure.Of them,37（34.9%） patients were HBeAg-positive and 69（65.1%） were HBeAg-negative.Forty-six（43.4 %） patients received antiviral therapy after admission.Fifty-five（51.9%） patients had improved prognosis and fifty-one（48.1%） had deteriorated prognosis.Univariate Logistic regression analysis showed that prognosis was significantly related to severity of basic liver disease,total bilirubin,direct bilirubin,albumin,serum sodium,serum chloride,prothrombin time,complicating bacterial infection,hepatic encephalopathy,electrolyte disturbance,hepatorenal syndrome,and antiviral therapy after admission（P 0.05）.Multivariate Logistic regression analysis demonstrated that prognosis was significantly related to severity of basic liver disease,prothrombin time and antiviral therapy after admission（P 0.05）.【Conclusion】 Severity of basic liver disease and prothrombin time are the independent risk factors and antiviral therapy can improve prognosis of HBV-related liver failure.

关 键 词：肝炎病毒 乙型 肝衰竭 预后 危险因素 

分 类 号：R512.62[医药卫生—内科学]