乙型肝炎肝衰竭患者并发肝肾综合征的高危因素分析  

The risk factor analysis of hepatorenal syndrome in patients with Hepatitis B-related Acute-on-Chronic Liver Failure

作　　者：刘宝荣 杨世达 甘巧蓉 黄水文 张冬青 潘晨 李东良[2] Liu Bao-rong1 , Yang Shi-da1 , Can Qiao-rong1 ,Li Dong-liang2 ,et al.(1. Department of Hepatology, Mengchao Hepatobiliary Hospital of Fujian Medical University（ Fuzhou, Fujian 350025, China）)

机构地区：[1]福建医科大学孟超肝胆医院肝病科,福建福州350025 [2]解放军福州总医院肝胆内科

出　　处：《中西医结合肝病杂志》2018年第2期75-78,共4页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金："十二五"国家科技重大专项(No.2012ZX10002004);福州市卫生局科技计划项目(No.2014-S-W26)

摘　　要：目的:探讨乙型肝炎慢加急性(亚急性)肝衰竭患者并发肝肾综合征的危险因素。方法:以736例乙型肝炎慢加急性(亚急性)肝衰竭患者为研究对象,采用单因素分析及多因素Logistic回归分析并发肝肾综合征与未并发肝肾综合征患者,观察患者一般情况、临床血液检测指标、肝脏大小及肝衰竭其他常见并发症等因素与肝肾综合征发生的相关性,并探讨肝肾综合征发生情况与患者90天预后的关系。结果:单因素分析显示乙型肝炎慢加急性(亚急性)肝衰竭合并肝肾综合征患者HBe Ag阴性率、基线CHOL、AFP、凝血酶原活动度、肝左叶长径、肝右叶斜径均显著低于未并发肝肾综合征患者,而年龄、血Cr、INR则显著高于未并发肝肾综合征(P<0.01或0.05)。单因素及多因素Logistic回归分析均显示肝性脑病、自发性腹膜炎、真菌感染、上消化道出血、PTA降低、肝右叶斜径缩小为慢加急性(亚急性)肝衰竭并发肝肾综合征高危险因素,与HRS的发生密切相关。HRS的发生与乙型肝炎慢加急性(亚急性)肝衰竭90天的短期预后相关。结论:肝性脑病、自发性腹膜炎、真菌感染、上消化道出血、凝血酶原活动度降低、肝右叶斜径缩小为乙型肝炎慢加急性(亚急性)肝衰竭并发肝肾综合征的高危险因素,临床应积极预防和及早干预。Objective： To investigate the risk factors of hepatorenal syndrome（ HRS） in patients with Hepatitis B-related acute-on-chronic liver failure（ ACLF）. Methods： 736 Hepatitis B-related ACLF patients were enrolled and divided into HRS group and non-HRS group.The baseline demographic,clinical,biochemical,virological features,the bulk of liver,and whether complications occured or not in these patients were collected. Univariate analysis and Logistic regression were applied to identify the influencing factors of HRS. The survival curve was established to analyze the association between HRS and 3-month mortality of ACLF. Results： The ratio of hepatitis B virus e antigen（ HBe Ag）,the data of cholesterol（ CHOL）,alpha-fetoprotein（ AFP）,prothrombin activity（ PTA）,left hepatic size,and right hepatic size in HRS group were lower than non-HRS group. While the age,the data of serum cretinine（ Cr）,and plasma ratio of international standardization（ INR） in HRS group were higher than non-HRS group,the difference were statistically significant（ P〈0. 05）. The ratio of the hepatic encephalopathy（ HE）,primary peritonitis,mycotic infection,upper gastrointestinal hemorrhage,prothrombin activity（ PTA）,and right hepatic size were the risk factors of HRS in patients with Hepatitis B-related ACLF. HRS was associated with increased 3-month mortality in Hepatitis B-related ACLF patients. Conclusion： The ratio of the hepatic encephalopathy（ HE）,primary peritonitis,mycotic infection,upper gastrointestinal hemorrhage,prothrombin activity（ PTA）,and right hepatic size were the risk factors of HRS in patients with Hepatitis Brelated ACLF. It suggests that we should prevent this complication actively and intervene it as early as possible.

关 键 词：乙型肝炎 慢加急性(亚急性)肝衰竭 肝肾综合征 Logistic回归分析 

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