乙型肝炎肝衰竭患者发生肝性脑病的多因素分析  

Multivariate analysis of hepatic encephalopathy occurrence in patients with liver failure

作　　者：潘晨[1] 许利军[1] 周锐[1] 周文[1] 黄建荣[2] 

机构地区：[1]福建医科大学附属传染病医院,350025 [2]浙江大学医学院附属第一医院传染病国家诊治重点实验室

出　　处：《中华肝脏病杂志》2012年第6期434-437,共4页Chinese Journal of Hepatology

基　　金：基金项目：艾滋病和病毒性肝炎等重大传染病防治科技重大专项（2008ZX10002-005）;福州市科技计划项目（2009-G-102）

摘　　要：目的探讨乙型肝炎肝衰竭患者发生肝洼脑病的危险因素，以便于临床早期干预，减少肝性脑病的发生。方法收集976例乙型肝炎肝衰竭患者的基础临床资料（性别、年龄、家族史、肝硬化、糖尿病、腹腔感染、肺部感染、肝肾综合征、上消化道出血）和临床检测指标[白蛋白、球蛋白、总胆红素、直接胆红素、ALT、AST、γ-谷氨酰转移酶、碱性磷酸酶、胆固醇、胆碱酯酶、血钾、血钠、肌酐、国际标准化比值（INR）、甲胎蛋白、HBVDNA、白细胞计数、血红蛋白和血小板】，进行单因素和多因素回归分析，筛选乙型肝炎肝衰竭患者肝性脑病发生的危险因素。结果多元logistic回归分析结果显示，上消化道出血（回归系数为0．993，比值比为2．699，95％可信区间为1．567～4．651）、肺部感染（回归系数为1．043，比值比为2．839，95％可信区间为1．680～4．797）、INR（回归系数为0．257，比值比为1．293，95％可信区间为1．220～1．370）、AST（回归系数为0．001，比值比为1．001，95％可信区间为1．000～1．001）和肝硬化（回归系数为0．569，比值比为1．815，95％可信区间为1．112～2．965）是影响肝衰竭患者肝性脑病发生的危险因素。结论上消化道出血、肺部感染、INR延长、AST升高以及肝硬化是诱发肝衰竭患者发生肝性脑病的重要危险因素。Objective To investigate the risk factors of hepatic encephalopathy in patients with liver failure. Methods Nine-hundred-and-seventy-six hepatitis B virus （HBV） patients with liver failure were retrospectively analzyed. Clinical data （sex, age, family history, liver cirrhosis, diabetes, celiac infection, pulmonary infection, liver kidney syndrome, upper gastrointestinal hemorrhage） and laboratory findings （albumin, globulin, total bilirubin, direct bilirubin, alanine aminotransferase, aspartate aminotransferase （AST）, gamma-glutamyl transferase, alkaline phosphatase, cholesterol, cholinesterase, K＋, Na＋, creatinine, international normalized ratio （INR）, alpha-fetoprotein, HBV DNA, white blood cell, hemoglobin, platelet） were collected and used to screen the risk factors for hepatic encephalopathy by univariate and multiple regress analyses. Results Multiple logistic regression analysis indicated that upper gastrointestinal hemorrhage [risk （R）= 0.993, relative hazard （RH）= 2.699, 95% confidence interval （CI）： 1.567-4.651], pulmonary infection JR= 1.043, RH= 2.839, 95%6I： 1.680-4.797], INR [R=0.257, RH= 1.293, 95%CI： 1.220-1.370], AST level [R =0.001, RH= 1.001, 95%CI： 1.000-1.001], and cirrhosis [R =0.569,RH= 1.815, 95%CI： 1.112-2.965] were closely correlated with hepatic encephalopathy. Conclusion HBV-infected patients presenting with upper gastrointestinal haemorrhage, pulmonary infection, prolonged INR, elevated AST, or liver cirrhosis should be carefully monitored for indications of hepatic encephalopathy to initiate timely therapeutic interventions.

关 键 词：肝功能衰竭 肝性脑病 肝炎 乙型 预后  回归分析 

分 类 号：R575.3[医药卫生—消化系统]