96例肝功能衰竭患者主要并发症与预后的相关性  

Relationship between major complications and prognosis of 96 patients with liver failure

作　　者：赵俊梅[1] 赵培利[1] 张璐[2] 邱海燕[1] 李艳静[1] 段银环[1] 孙谢文[1] 邢剑侠[1] 刘坤[1] 赵志军[1] 陈璀[1] 刁青[1] 王建英[1] 李明慧[2] 谢尧[2] ZHAO Jun-mei;ZHAO Pei-li;ZHANG Lu;QIU Hai-yan;LI Yan-jing;DUAN Yin-huan;SUN Xie-wen;XING Jian-xia;LIU Kun;ZHAO Zhi-jun;CHEN Cui;DIAO Qing;WANG Jian-ying;LI Ming-hui;XIE Yao(Department of Liver Diseases,the Third Hospital of Qinhuangdao,Qinhuangdao 066000,Hebei Province,China;Liver Diseases Center,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]秦皇岛市第三医院肝病科,河北秦皇岛066000 [2]首都医科大学附属北京地坛医院肝病中心,北京100015

出　　处：《中国肝脏病杂志（电子版）》2018年第3期77-81,共5页Chinese Journal of Liver Diseases：Electronic Version

基　　金：秦皇岛市科学技术局项目(201401A226);首都医科大学附属北京地坛医院“启航”课题(DTQH201610);北京市科技计划子课题(D161100002716002);北京市医院管理局消化协同中心项目(XXZ0302)

摘　　要：目的回顾性分析96例肝功能衰竭患者的临床特点、主要并发症和预后的关系。方法收集2008年1月至2014年12月首都医科大学附属北京地坛医院收治的96例肝衰竭患者的临床资料,分析肝性脑病、上消化道出血、肝肾综合征、腹水和腹腔感染等主要并发症与预后的关系。结果 (1)96例肝功能衰竭患者中男性68例,女性28例,平均年龄(44.91±13.30)岁。存活60例,平均年龄(43.60±11.14)岁,病死36例,平均年龄(47.18±16.32)岁,差异无统计学意义(t=1.120,P=0.268)。(2)根据发病速度、严重程度和基础肝病情况,96例患者中亚急性肝功能衰竭17例(17.71%),慢性肝炎基础上的慢加急/亚急性肝功能衰竭17例(17.71%),肝硬化基础上的慢性肝功能衰竭62例(64.58%)。有肝性脑病表现者60例(62.50%)。(3)所有患者中病死36例,总体病死率为37.50%。单因素分析表明上消化道出血、肝性脑病和肝肾综合征与肝功能衰竭患者病死显著相关(χ~2=10.41,P=0.001;χ~2=13.70,P<0.001;χ~2=42.84,P<0.001)。并发肝性脑病患者的病死率显著高于未并发者(51.67%vs 13.89),差异有统计学意义(χ~2=13.70,P<0.001)。多因素分析表明Ⅲ、Ⅳ期肝性脑病和肝肾综合征是肝功能衰竭患者病死的独立预测因素(OR=30.509,95%CI:6.212～149.845;OR=69.161,95%CI:12.216～391.571)。结论Ⅲ、Ⅳ期肝性脑病和肝肾综合征是肝功能衰竭病死的独立预测因素。Objective To investigate the relationship among clinical features, main complications and prognosis of 96 patients with liver failure retrospectively. Methods The clinical data of 96 cases with liver failure in Beijing Ditan Hospital, Capital Medical University from January 2008 to December 2014 were collected, the relationship between main complications including hepatic encephalopathy, upper gastrointestinal bleeding, hepatorenal syndrome, ascites, abdominal infection and prognosis were analyzed. Results ①In the 96 cases with liver failure, there were 68 males and 28 females with an average age of （44.91 ± 13.30） years; there were 60 patients who were survived with an average age of （43.60 ± 11.14） years and 36 patients who were dead with an average age of （47.18 ± 16.32） years, the difference was statistically significant （t = 1.120, P = 0.268）. ②According to the progression rate of hepatitis and basic liver conditions, total of 17 cases （17.71 %） cases were subacute liver failure, 17 cases （17.71%） were acute-on-chronic/ subacute liver failure based on chronic hepatitis and 62 cases （64.58 %） were cirrhosis liver failure. Clinical manifestations with hepatic encephalopathy accounted for 62.50% （60 cases）. ③Total of 36 patients died and the overall mortality was 37.50%. Single factor analysis showed that upper gastrointestinal hemorrhage, hepatic encephalopathy and hepatorenal syndrome were significantly associated with death in patients with liver failure （χ 2 = 10.41, P = 0.001; χ 2 = 13.70, P 〈 0.001; χ 2 = 42.84, P 〈 0.001）. The mortality of patients with hepatic encephalopathy was significantly higher than that of patients without hepatic encephalopathy （51.67% vs 13.89%）, the difference was statistically significant （χ 2 = 13.70,P 〈 0.001）. Multifactorial logistic regression analysis showed that Ⅲ and Ⅳ phase hepatic encephalopathy and hepatorenal syndrome were independent risk factors for liver failure （OR = 30.509, 95%CI： 6.212～14

关 键 词：肝功能衰竭 并发症 预后 

分 类 号：R575.3[医药卫生—消化系统]