肝性脑病患者预后的危险因素分析  

Study on the Risk Factors Influencing the Prognosis of Hepatic Encephalopathy

作　　者：吕日英[1] 李仕雄[1] 

机构地区：[1]广西医科大学第八附属医院感染科,广西省贵港市537100

出　　处：《中华全科医学》2012年第11期1687-1689,共3页Chinese Journal of General Practice

摘　　要：目的研究肝性脑病患者预后的危险因素。方法收集290例肝性脑病患者的40项临床指标,运用Logis-tic回归模型分析这些因素与预后的关系。结果 290名患者中好转102例,恶化死亡188例,病死率64.8%(188/290)。多因素Logistic回归模型分析,与肝性脑病患者预后有统计学意义的因素有:肝肾综合征(HRS)(OR=16.27,95%CI:3.52～74.90)、腹水(OR=7.00,95%CI:2.12～23.10)、原发性细菌性腹膜炎(SBP,OR=7.00,95%CI:2.12～23.10)、肌酐(OR=1.02,95%CI:1.01～1.03)、血氨(OR=1.02,95%CI:1.00～1.03)、凝血酶原活动度(PTA,OR=0.56,95%CI:0.47～0.65)。结论 HRS、腹水、SBP、肌酐、血氨、PTA是肝性脑病预后的独立危险影响因素,提示尽早采取有针对性的措施预防并发症的发生,并动态监测PTA、血清肌酐及血氨,有望降低病死率。Objective To study the risk factors influencing prognosis of hepatic encephalopathy. Methods Clinical data from 290 patients were analyzed retrospectively. 40 clinical and laboratory parameters were collected as predictive risk factors. The rela- tion between risk factors and prognosis of hepatic encephalopathy was explored by logistic regression analysis. Results Among the 290 patients, 102 cases recovered and 188 cases dead, the case fatality rate was 64.8% （188/290）. Logistic regression analy- sis showed that the factors associated with prognosis of hepatic encephalopathy were： Hepatorenal syndrome （ OR = 16.27,95 % CI：3.52 -74.90） ,Ascites（ OR =7.00,95% CI：2.12 - 23.10） ,Spontaneous bacterial peritonitis（ OR = 3.01,95% CI：2.04 - 18.01 ）, Creatinine （ OR = 1.02,95% CI ： 1.01 - 1.03 ）, Ammonia （ OR = 1.02,95% CI ： 1.00 - 1.03 ）, Prot-hrombin activity （0R=0.56,95% CI：0.47 -0.65）. Conclusion Hepatorenal syndrome, ascites, spontaneous bacterial peritonitis,creatinine, ammonia and prothrombin activity were important influencing factors in prognosis of hepatic encephalopathy. It was suggested that some effective countermeasures should be taken to reduce the incidence of complications, and dynamic monitoring of prothrombin activity, ammonia and serum ereatinine were expected to reduce the mortality.

关 键 词：肝性脑病 预后 危险因素 LOGISTIC回归分析 

分 类 号：R575.3[医药卫生—消化系统] R747.9[医药卫生—内科学]