乙型肝炎肝硬化失代偿期患者死亡的危险因素分析  

Analysis on risk factors of death in hepatitis B cirrhosis patients during decompensated period

作　　者：李海军[1] 郭志梅[2] 杨新英[1] 康富标[1] 孙殿兴[1] 

机构地区：[1]解放军白求恩国际和平医院肝病传染科,石家庄050082 [2]解放军白求恩国际和平医院新生儿科,石家庄050082

出　　处：《国际流行病学传染病学杂志》2016年第1期10-13,共4页International Journal of Epidemiology and Infectious Disease

摘　　要：目的：探讨导致乙型肝炎肝硬化失代偿期患者死亡的危险因素。方法选取2010年1月1日至2015年6月30日在白求恩国际和平医院肝病传染科住院的238例乙型肝炎肝硬化失代偿期死亡患者作为死亡组，并选择同期好转出院的238例患者作为对照组，对比分析导致患者死亡的危险因素。结果死亡组患者死亡原因主要为慢性肝功能衰竭（44.96%）、感染（21.43%）、肝肾综合征（17.65%）及上消化道出血（13.03%）。死亡组患者的WBC为（7.28±2.15）×10^9/L、AST为（287.64±74.28）U/L，TBil为（302.14±152.34）μmol/L，血肌酐为（174.62±45.31）mmol/L，均高于对照组，两组差异均有统计学意义（t=4.229、26.372、28.365和27.336， P 均〈0.01）。死亡组的凝血酶原时间活动度为（25.64±9.26）%，球蛋白为（18.32±6.21）g/L，血钠为（110.38±14.57）mmol/L，均低于对照组，差异有统计学意义（t=-5.134、-3.702和-1.754，P均〈0.01）。死亡组合并慢性肝功能衰竭、自发性细菌性腹膜炎、肝肾综合征和败血症发生率分别为52.94%、36.13%、30.25%和11.34%，均高于对照组，差异均有统计学意义（χ^2=16.385、6.846、10.261和8.765，P均〈0.01）。合并慢性肝功能衰竭、肝肾综合征、WBC＞6.00×10^9/L、血肌酐＞160.00 mmol/L、球蛋白＜20.00g/L和血钠＜110.00 mmol/L为乙型肝炎肝硬化失代偿期患者死亡的危险因素（OR=15.386、6.237、4.682、1.829、3.183和2.351）。结论慢性肝功能衰竭、肝肾综合征、WBC＞6.00×10^9/L、血肌酐＞160.00 mmol/L和血钠＜110.00 mmol/L是乙型肝炎肝硬化失代偿期患者死亡的主要原因及危险因素。乙型肝炎肝硬化失代偿期患者在保肝的同时更应该保护肾功能、预防感染及改善全身炎症反应。Objective To discuss the risk factors of death in hepatitis B cirrhosis patients during decompensated period. Methods There were 238 died hepatitis B cirrhosis patients during decompensated period who were treated in Bethune International Peace Hospital from January 1st, 2010 to June 30th, 2015 selected as death group, and 238 improved patients as control group at the same time. The risk factors of death were investigated. Results The causes of death were mainly chronic hepatic failure （44.96%）, infection （21.43%）, hepatorenal syndrome（17.65%） and upper gastrointestinal hemorrhage（13.03%）. The levels of WBC[（7.28±2.15）×10^9/L], AST [（287.64±74.28）U/L], TBil [（302.14±152.34）μmol/L] and serum creatinine [（174.62±45.31）mmol/L] in death group were all higher than control group, and the differences were statistically significant （t=4.229, 26.372, 28.365 and 27.336, P all〈0.01）. The prothrombin time activity percentage [（25.64±9.26）%], globulin [（18.32±6.21） g/L] and serum sodium [（110.38 ±14.57）mmol/L] in death group were lower than control group, with statistically significantdifferences （t=-5.134,-3.702 and-1.754,P all〈0.01）. The complication of chronic hepatic failure （52.94%）, spontaneous bacterial peritonitis（36.13%）, hepatorenal syndrome（30.25%） and septicemia（11.34%） in death group were higher than those in control group, and the differences had statistical significance （χ^2=16.385, 6.846, 10.261 and 8.765;P all 〈0.01）.In multivariate analysis, the presence of chronic hepatic failure,hepatorenal syndrome, WBC〉6.00 ×10^9/L, serum creatinine〉160.00 mmol/L, globulin〈20.00g/L and serum sodium〈110.00 mmol/L were the death risk factors in patients of decompensated hepatitis B cirrhosis （OR=15.386, 6.237, 4.682, 1.829, 3.183 and 2.351）. Conclusions The chronic hepatic failure, WBC〉6.00×10^9/L, serum creatinine〉160.00 mmol/L, globulin〈20.00 g/L and serum sodium〈110.00 mmol/L are the main causes and risk factors

关 键 词：肝硬化 危险因素 临床研究 预后 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]