慢加急性（亚急性）肝衰竭及慢性肝衰竭预后危险因素分析  

Analysis of risk factors affecting the prognosis of （sub） acute-on-chronic liver failure and chronic liver failure

作　　者：王成成[1] 黄芬[1] 

机构地区：[1]中国医科大学附属盛京医院感染科,沈阳110020

出　　处：《临床内科杂志》2015年第2期112-115,共4页Journal of Clinical Internal Medicine

摘　　要：目的探讨慢加急性（亚急性）肝衰竭及慢性肝衰竭预后不良危险因素。方法收集我院近3年收治的慢加急性（亚急性）肝衰竭及慢性肝衰竭患者临床资料；根据预后分为好转组与恶化组；重点分析病程超过1周的122例肝衰竭患者预后不良的危险因素，应用Logistic回归分析得出独立危险因素，构建预后方程，并应用ROC曲线下面积（AUC）评价其对预后的预测效能。结果慢加急性（亚急性）肝衰竭与慢性肝衰竭预后比较差异无统计学意义（P〉0．05）。乙肝病毒感染与非乙肝病毒感染者预后比较差异无统计学意义（P〉0．05）。48例应用核苷类药物的乙肝相关肝衰竭白行停药者预后差（P〈0．05）。恶化组自发性细菌性腹膜炎（SBP）、肝性脑病（HE）、肝肾综合征（HRS）的发生率高于好转组（P〈0．05），基线凝血酶原国际标准化比值（INR）明显高于好转组（P〈0．01），基线血清白蛋白（ALB）、血红蛋白（Hb）、血小板（PLT）水平明显低于好转组（P〈0．05）．对上述因素行Logistic回归分析，发现INR及HE是预后的独立危险因素；Logit（P）〈0．1648者，恶化的可能性为95．1％；INR〈1．75者，好转可能性为76．6％。结论乙肝相关肝衰竭自行停用核苷类药物是预后不良的危险因素。ALB、INR、Hb、PI．T、SBP、HE、HRS的发生影响肝衰竭预后。INR及HE是肝衰竭患者预后不良的独立危险因素。objective To investigate the risk factors affecting the prognosis of （sub） acute-on- chronic liver failure and chronic liver failure. Methods Clinical data from 122 cases of （sub） acute-on- chronic liver failure and chronic liver failure in recentthree years in our hospital were analyzed retrospec- tively, including clinical classification, causes, age, gender, hepatic cirrhosis, complications, and laboratory results. Correlated degree between those single factors and prognosis was explored. Independent risk factors were explored and a prognostic equation was built by logistic regression analysis. The efficacy of the prog- nostic assessment was examined by AUC. Results There was no significant difference in prognosis be- tween（sub） acute-on-chronic liver failure and chronic liver failure. The difference was not significant in prognosis between hepatitis b virus（HBV） related cases and other cases. Of cases related HBV,48 cases received treatment of nucleoside analogues, and the patients who quit taking drugs optionally had a poor prognosis（P 〈 0.05 ）. The incidence of hepatic encephalopathy （HE）, spontaneous bacterial peritonitis （SBP） ,hepatorenal syndrome（HRS） and the baseline level of international normalized ratio（INR） in de- terioration group were higher than those in improved group（ P 〈 O. 05 ）. The baseline levels of serum albu- min（ALB）, hemoglobin （Hb）, blood platelet （PI,T） in deterioration group were lower than those in im- proved group（ P 〈0.05 ）. Multiple logistic regression analysis indicated that INR and HE were independ- ent risk factors affecting the prognosis of liver failure. Meanwhile, the prognostic equation was built ： Logit （P） = 5. 791-1. 367HE（ yes 1 ,no 0） -3. 456INR ; If Logit （P） less than 0. 1648 ,the possibility of deterio- ration was 95.1% ; If INR less than 1.75,there was a 76.6% chance of improvement. Conclusion Quit- ting nucleoside analogues optionally is a risk factor affecting the prognosis of HBV relat

关 键 词：肝衰竭 预后 肝性脑病 凝血酶原国际标准化比值 

分 类 号：R541.4[医药卫生—心血管疾病]