乙肝相关慢加急性肝衰竭患者合并肝性脑病的影响因素  

Influencing Factors of Hepatitis B Associated Acute - on - chronic Liver Failure Combined with Hepatic Encephalopathy

作　　者：刘宝荣 周锐 杨世达 甘巧蓉 黄水文 潘晨 林春 Liu Baorong, Zhou Rui, Yang Shida, et al.(Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, Chin)

机构地区：[1]福建医科大学孟超肝胆医院/福建医科大学附属传染病医院,福建福州350025

出　　处：《医学新知》2018年第1期21-24,共4页New Medicine

基　　金：“十二五”国家科技重大专项一重型乙型肝炎（肝功能衰竭）临床治疗新方案的研究（2012ZX10002004）;福州市科技计划项目（2013-S-125-8）;福州市卫生局科技计划项目（2014-S-W26）

摘　　要：目的探讨乙肝相关慢加急性肝衰竭患者合并肝性脑病的影响因素。方法收集我院830例乙肝相关慢加急性肝衰竭患者一般临床资料和基线临床检测指标。采用回顾性分析方法，分别采用单因素分析及二分类多因素logistic回归分析，探讨肝性脑病影响因素。结果830例乙肝相关慢加急性肝衰竭患者中肝性脑病患者278例（33．5％），其中男244例（29．4％），女34例（4．1％）。单因素分析结果提示：年龄、总胆红素与直接胆红素比值、胆固醇浓度、血钠浓度、凝血酶原活动度、国际标准化比值（INR）、甲胎蛋白浓度、白细胞绝对计数、中性粒细胞比值和血小板计数在合并肝性脑病和未合并肝性脑病的两组乙肝相关慢加急性肝衰竭患者有统计学意义差异。Logistic回归分析结果提示，年龄、总胆红素与直接胆红素比值、凝血酶原活动度、国际标准化比值（INR）、甲胎蛋白浓度、HBV-DNA水平、白细胞绝对计数、中性粒细胞比值对肝性脑病的发生有重要的影响。结论乙肝相关慢加急性肝衰竭患者合并肝性脑病的危险因素有年龄增大、总胆红素与直接胆红素比值升高、凝血酶原活动度降低、国际标准化比值（INR）升高、甲胎蛋白浓度降低、HBV-DNA水平高、白细胞绝对计数升高、中性粒细胞比值升高。Objective To explore influencing factors of hepatitis B associated acute - on - chronic liver failure combined with hepatic encephalopathy. Methods Clinical data and baseline indicators of 830 patients with hepatitis B associated acute - on - chronic liver failure admitted in our hospital were collected. Univariate analysis and multiple binary logistic regression analysis were performed to explore influencing factors of hepatic encephalopathy. Results Among 830 patients, 278 patients combined with hepatic encephalopathy（33.5% ）, 244 patients of whom were male （29.4%） and 34 patients were female（4.1% ）. The results of univariate analysis were as follows： there were significant differences on age, TBIIZDBIL ratio, CHO, Na ＋ , PTA, INR, AFP, WBC, GR and PLT between hepatic encephalopathy patients and non - hepatic encephalopathy patients. Logistic regression analysis showed that age, TBIL/ DBIL ratio, PTA, INR, AFP, HBV - DNA, WBC, GR were influencing factors of hepatic encephalopathy. Conclusion The risk factors of hepatitis B associated acute - on - chronic liver failure combined with hepatic encephalopa- thy are age, high TBIL/DBIL ratio, low PTA, high INR, low AFP, high HBV - DNA, high WBC and high GR.

关 键 词：乙型肝炎病毒 肝功能衰竭 比例风险模型 回归分析 预后 

分 类 号：R575.3[医药卫生—消化系统]