肝硬化伴全身炎症反应综合征患者预后影响因素的Logistic回归分析  

Logistic regression analysis on prognostic influence factors of liver cirrhosis patients with systemic inflammatory response syndrome

作　　者：杨丹红[1] 潘红英[1] 黄益澄[1] 陈丽[2] 陈美娟[1] 童永喜[1] 

机构地区：[1]浙江省人民医院感染科,杭州310014 [2]浙江中医药大学附属第二医院超声科,杭州310005

出　　处：《国际流行病学传染病学杂志》2016年第5期294-299,共6页International Journal of Epidemiology and Infectious Disease

基　　金：浙江省医药卫生科技计划（2014KYA022）;浙江省科技厅公益性项目（2015C33165）

摘　　要：目的探讨肝硬化伴全身炎症反应综合征（SIRS）患者预后的影响因素。方法对136例肝硬化伴SIRS患者进行回顾性分析，根据患者病情转归分为死亡组（52例）与存活组（84例），比较两组患者临床资料，应用Logistic回归分析筛选肝硬化伴SIRS死亡相关的独立危险因素。结果单因素分析结果显示，死亡组的白蛋白、胆碱酯酶水平分别为（27．68±4．84）g／L和（2647．12±1057．18）U／L，均低于存活组（t=0．007，P〈0．01；t=0．017，P〈0．05）；死亡组血肌酐（Cr）、空腹血糖水平、白细胞总数、C反应蛋白（CRP）和降钙素原（PCT）水平的中位数分别为175．40μmol／L、5．43mmol／L、8．10×10 9／L、24．00mg／L和1．20μg/L，均高于存活组（Z=0．000、0．000、0．009、0．012和0．013，P均〈0．05）；此外，死亡组的中性粒细胞百分比、肝性脑病发生率、消化道出血发生率、Child—pughC级比例、败血症发生率、肺部感染发生率和多部位感染发生率分别为（76．73±14．02）％、28．85％、34．62％、44．23％、34．62％、73．08％和90．38％，均高于存活组，差异均有统计学意义（t=0．009f=28．950、42．810、18．260、16．680、41．177和78．440，P均〈0．05）。成组Logistic逐步回归筛选结果有意义的因素为：Cr〉165 μmol／L（OR=6．590，95％CI：1．907-22．778）、消化道出血（OR=29．207，95％CI：4．506-189．290）、CRP〉25mg／L（OR=9．757，95％CI：1．732—54．969）、PCT〉1μg／L（OR=20．350，95％CI：2．617-158．264）和多部位感染（OR=30．760，95％CI：2．934—322．572）。结论Cr〉165μmol／L、消化道出血、CRP〉25mg／L、PCT〉1μg/L和多部位感染是肝硬化伴SIRS患者死亡的独立危险因素。Objective To investigate the prognostic influence factors of liver cirrhosis patients with systemic inflammatory response syndrome （SIRS） . Methods A total of 136 liver cirrhosis patients with SIRS were analyzed retrospectively, and were divided into death group （n=52） and survival group（n=84） by the outcome of the disease. The clinical data in 2 groups were compared. The independent risk factors of death in liver cirrhosis patients with SIRS were analyzed by Logistic regression. Results The result of single-factor analysis revealed that the levels of albumin （ALB） and cholinesterase （C HE ） in death group were （27.68±4.84） g/L and （ 2 647.12±1057.18 ） U/L, and were both lower than those in survival group （t=0.007, P〈0.01 ; t=0.017, P〈0.05）. The levels of serum creatinine （Cr） ,fasting blood-glucose （FBS）, total white blood cell count, serum CRP and PCT in death group were 175.40 μmol/L, 5.43 mmol/L, 8.10×10 9/L, 24.00 mg/L and 1.20 μg/L, and were higher than those in survival group （Z=0.000, 0.000, 0.009, 0.012 and 0.013, P all 〈0.05）. In addition, the neutrophil proportion, incidence rates of hepatic encephalopathy, gastrointestinal hemorrhage, Child-pugh C grade, sepsis, pulmonary infection and multiple sites of infection in death group were （76.73±14.02）%, 28.85%, 34.62%, 44.23%, 34.62%, 73.08% and 90.38%, and were higher than those in survival group （t=0.009,X2=28.950,42.810,18.260, 16.680, 41.177 and 78.440, Pall 〈0.05）. Logistic regression stepwise screening results showed that Cr〉165 μmol/L （OR=6.590, 95%CI： 1.907-22.778）, gastrointestinal hemorrhage （OR=29.207, 95%CI： 4.506- 189.290）, CRP〉25 mg/L （OR=9.757, 95%CI： 1.732-54.969）, PCT〉1 μg/L （OR=20.350, 95%CI： 2.617-158.264） and multi-site infection （OR =30.760, 95% CI： 2.934-322.572） were significant factors. Conclusions Cr〉165 μmol/L, gastrointestinal hemorrhage, CRP〉25 mg/L, PCT〉 1μg/L and multi-site infection are regarded as independent risk

关 键 词：肝硬化 全身炎症反应综合征 预后 危险因素 

分 类 号：R575.2[医药卫生—消化系统]