儿童急性肝衰竭的病因构成分析及短期疗效评价  

Etiological analysis and short-term efficacy evaluation of acute liver failure in children

作　　者：马威[1] 孙娟[1] 王晓玲 李方[1] 王怀立[1] Ma Wei;Sun Juan;Wang Xiaoling;Li Fang;Wang Huaili(Department of Pediatric Intensive Care Unit,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院PICU,450052

出　　处：《中华肝脏病杂志》2020年第11期959-963,共5页Chinese Journal of Hepatology

摘　　要：目的探索儿童急性肝衰竭病因构成,优化病因查找方向、评估短期疗效。方法收集2011年11月至2019年11月就诊于郑州大学第一附属医院并确诊的儿童急性肝衰竭病例,统计不同性别、年龄段、居住环境、发病季节的病因构成,并分析不同病因的短期预后情况。率的比较和组间构成比比较采用χ2检验或Fisher确切概率法。结果236例病例中,病因不明者114例(48.31%),病因明确者122例(51.69%)。在病因明确组中,药物/毒物相关38例(16.10%),感染性相关27例(11.44%),先天发育性/血管性/胆道性相关22例(9.32%),遗传代谢性疾病15例(6.36%),肿瘤相关17例(7.20%),自身免疫性疾病3例(1.27%);且整体病因分布在不同性别、年龄别及发病季节等因素上差异无统计学意义(P>0.05),而在不同居住环境上差异有统计学意义(P<0.05);不同首诊科室的确因率也不同,其中,肝移植科最高(78.26%),儿科最低(26.09%)。在病因明确的122例患儿中,不同病因组之间在性别比例上差异无统计学意义(P>0.05),在年龄别、居住环境和发病季节上差异有统计学意义(P<0.05)。其中<3岁患儿以先天发育/血管性/胆道性和感染性相关为主,而>3岁患儿以药物/毒物相关原因为主;农村患儿以药物/毒物相关原因和感染性相关原因居多,而城市患儿以肿瘤及药物/毒物相关居多;且夏秋季以药物/毒物相关为主,冬春季以感染相关为主。在病因不明组中,内科治疗与外科治疗组相比,临床治愈+好转率之间差异无统计学意义(37.50%比20.00%,P>0.05);而在病因明确组中,上述差异有统计学意义(43.96%比83.87%,P<0.05)。不同病因组之间先天发育性/血管性/胆道性组短期疗效最好(72.72%,16/22),药物/毒物相关组次之(60.53%,23/38),肿瘤相关组最差(23.53%,4/17)。结论儿童急性肝衰竭约有一半尚不能明确病因,明确病因的患儿其人群分布与年龄、居住环境和季节有关,与性别无关。而Objective To explore etiology,optimize the search direction of etiology,and short-term efficacy evaluation of acute liver failure in children.Methods Children with acute liver failure who were diagnosed in the First Affiliated Hospital of Zhengzhou University from November 2011 to November 2019 were collected.Gender difference,age,living environment,etiological factors on the seasonal onset and different etiological profile of short-term prognosis were statistically analyzed.Chi-square test or Fisher's exact probability method was used to compare the rate and the constituent ratio between groups.Results Among the 236 cases,114(48.31%)had unknown etiology and 122(51.69%)had definite etiology.In the definite etiology group,38(16.10%),27(11.44%),22(9.32%),15(6.36%),17(7.20%),and 3(1.27%)cases were related to drugs/toxicants,infection,congenital/vascular/biliary diseases,genetic metabolic diseases,tumor-related,and autoimmune diseases.In addition,the overall etiological distribution did not change statistically with factors such as gender,age,and seasonal onset(P>0.05),while the difference in different living environments was statistically significant(P<0.05).Different initial-diagnosed departments had different etiological rates,with liver transplantation department being the highest(78.26%),and pediatrics department the lowest(26.09%).In 122 children with definite etiology,there was no significant difference in gender ratio between the different etiology groups(P>0.05),but there were significant differences in age,living environment and seasonal onset(P<0.05).Among them,congenital development/vascular/biliary tract and infectivity were the main factors in children<3 years old,and drug/toxin-related factors were the main factors in children>3 years old.Most of the rural children had drug/toxin and infection-related etiology,while most of the urban children had tumor and drug/toxin-related etiology.In summer and autumn,drug/toxicant correlation was dominant,while in winter and spring,infection correlation was dominan

关 键 词：急性肝衰竭 儿童 病因 疗效 

分 类 号：R725.7[医药卫生—儿科]