HBV相关慢加急性肝衰竭患者预后危险因素分析  

Prognostic factors for patients with hepatitis B virus-related acute-on-chronic liver failure

作　　者：李蓥[1] 詹婧[1] 王中峰[2] LI Ying ZHAN Jing WANG Zhongfeng(Gastrointestinal Endoscopy Center, The First Hospital of Jilin University, Changchun 130021, China)

机构地区：[1]吉林大学第一医院胃肠内科内镜中心,长春130021 [2]吉林大学第一医院肝胆胰内科,长春130021

出　　处：《临床肝胆病杂志》2017年第3期497-501,共5页Journal of Clinical Hepatology

摘　　要：目的探讨影响HBV相关慢加急性肝衰竭患者预后的因素,为临床诊治提供依据。方法收集2006年1月1日-2016年1月1日吉林大学第一医院收治的病历资料和随访结果完整的172例HBV相关慢加急性肝衰竭患者,回顾性分析其临床资料及各项实验室指标,找出影响预后的因素。计量资料2组间比较采用成组t检验,计数资料组间比较采用χ~2检验,将单因素分析有意义的指标引入logistic多因素回归分析,筛选出影响HBV相关慢加急性肝衰竭患者预后的独立危险因素。结果将单因素分析发现能影响预后的危险因素纳入logistic多因素回归分析,结果显示差异有统计学意义的变量为TBil、PTA、Na^+、TC、Child-TurcottePugh评分(CTP评分)、年龄≥50岁、有肝硬化基础、存在胆酶分离、出现并发症(P值分别为0.008、0.002、0.023、0.034、0.001、0.003、0.001、0.004、0.037)。将单因素分析发现能影响预后的并发症进行多因素回归分析,发现差异有统计学意义的变量为肝性脑病、肝肾综合征和感染(P值分别为<0.001、0.011、0.022)。结论影响HBV相关慢加急性肝衰竭患者预后的独立危险因素包括TBil、PTA、Na+、TC、CTP评分、年龄≥50岁、有肝硬化基础、存在胆酶分离、出现并发症。肝衰竭患者若合并肝性脑病、肝肾综合征和感染,则预后更差。早期判断肝衰竭患者的预后,预防和治疗相关并发症尤为重要。Objective To investigate the prognostic factors for patients with hepatitis B virus-related acute-on-chronic liver failure,and to provide a basis for clinical diagnosis and treatment.Methods A total of 172 patients with hepatitis B virus（HBV）-related acute-on-chronic liver failure who were admitted to The First Hospital of Jilin University from January 1,2006 to January 1,2016 and had complete medical records and follow-up data were enrolled,and a retrospective analysis was performed for their clinical data and laboratory markers to determine prognostic factors.The independent-samples t test was used for comparison of continuous data between groups,the chi-square test was used for comparison of categorical data between groups,and a multivariate logistic regression analysis was performed for the indices determined to be statistically significant by the univariate analysis to screen out independent risk factors for the prognosis of patients with HBV-related acute-on-chronic liver failure.Results The multivariate logistic regression analysis was performed for the indices determined to be statistically significant by the univariate analysis,and the results showed that the prognostic factors were total bilirubin（TBil）,prothrombin time activity（PTA）,Na＋,total cholesterol（TC）,Child-Turcotte-Pugh（CTP） score,age ≥50 years,the presence of liver cirrhosis,bilirubin-enzyme separation,and complications.The multivariate regression analysis was performed for the complications determined to affect prognosis by the univariate analysis,and the results showed that the complications as risk factors were hepatic encephalopathy,hepatorenal syndrome,and infection.Conclusion TBil,PTA,Na~＋,TC,CTP score,age ≥50 years,the presence of liver cirrhosis,bilirubin-enzyme separation,and complications are independent risk factors for the prognosis of patients with HBV-related acute-on-chronic liver failure.Liver failure patients with hepatic encephalopathy,hepatorenal syndrome,and infection tend to have poorer prognosi

关 键 词：肝炎病毒 乙型 肝功能衰竭 预后 危险因素 

分 类 号：R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学]