肝硬化并发肝肾综合征临床特点及死亡危险因素分析  

Clinical characteristics and death risk factors of cirrhosis complicated with hepatorenal syndrome

作　　者：王文苓[1] 苏晓峰 苏梅 晁华[1] 刘力畅[1] 王冶[1] 

机构地区：[1]解放军第三0二医院综合内科,北京100039 [2]解放军第三0七医院头颈部肿瘤与淋巴瘤科,北京100071 [3]解放军第三0七医院重症监护病房,北京100071

出　　处：《传染病信息》2017年第2期95-98,共4页Infectious Disease Information

基　　金：北京市科技计划首都临床特色应用研究专项(Z131100004013041)

摘　　要：目的探讨肝硬化基础上发生肝肾综合征(hepatorenal syndrome,HRS)患者的临床特点及死亡危险因素。方法回顾性分析274例肝硬化基础上发生HRS患者的临床特点。探讨患者性别、年龄、HRS分型、合并症、伴发基础疾病、生化指标以及治疗方案等对预后的影响。结果 274例患者中,男性207例(75.5%),女性67例(24.5%),平均年龄53.39岁;HRS Ⅰ型144例(52.6%),死亡42例,病死率为29.2%,从发病到死亡平均生存时间为(11.76±14.13)d;HRS Ⅱ型130例(47.4%),死亡12例,病死率为9.2%,发病到死亡平均生存时间为(17.41±17.04)d。病毒性肝炎肝硬化占病因构成的64.2%,酒精性肝硬化占25.5%。女性、HRSⅠ型、上消化道出血、肝性脑病、腹膜炎、低血钠是肝硬化并发HRS患者的死亡危险因素,特利加压素治疗是保护因素。结论肝硬化并发HRS患者的死亡危险因素众多,预后差,病死率高,特利加压素的应用可降低其死亡危险。Objective To investigate the clinical characteristics and death risk factors in patients who were cirrhosis and complicated with hepatorenal syndrome（HRS）. Methods Clinical characteristics were retrospectively analyzed on the 274 cirrhosis patients who were complicated with HRS. The effects of many factors on the prognosis were investigated, including gender, age, type of HRS, complications, underlying diseases, biochemical indexes and treatment. Results Of the 274 patients, 207 were male（75.5%） and 67 were female（24.5%）. The average age was 53.39 years old. Forty two cases died among 144 patients with typeⅠHRS, the case fatality rate was 29.2%, and the average survival time was（11.76 ± 14.13） d. Twelve cases died among 130 patients with typeⅡ HRS. The case fatality rate was 9.2% and the average survival time was（17.41 ± 17.04） d. Viral hepatitis related cirrhosis accounted for 64.2% of the total death, and alcoholic cirrhosis accounted for 25.5%. Female, typeⅠHRS, upper gastrointestinal bleeding, hepatic encephalopathy, peritonitis, hyponatremia were independent risk factors for cirrhosis patients complicated with HRS, and terlipressin treatment was the protective factor. Conclusions There are many death risk factors for the cirrhosis patients complicated with HRS. The prognosis of HRS is poor, and the fatality rate is high. Terlipressin treatment can reduce the risk of death in these patients.

关 键 词：肝肾综合征 肝硬化 临床特点 危险因素 特利加压素 

分 类 号：R575.2[医药卫生—消化系统]