肝硬化患者合并轻微肝性脑病与日常行为能力异常的关系及其危险因素分析  

Risk factors of mild hepatic encephalopathy and its relationship with disability of daily living activities in patients with liver cirrhosis

作　　者：刘子声 王志 邹勇斌 黄文超 Liu Zisheng;Wang Zhi;Zou Yongbin;Huang Wenchao(Department of Gastroenterology,Chenzhou Hospital Affiliated to Southern Medical University,First Affiliated Hospital of Xiangnan University,Chenzhou First People’s Hospital,Chenzhou,Hunan 423000,China;Department of Integrated Geriatric Medicine,Affiliated Hospital of Xiangnan University,Chenzhou,Hunan 423000,China;Department of Oncology,Chenzhou Hospital Affiliated to Southern Medical University,First Affiliated Hospital of Xiangnan University,Chenzhou First People’s Hospital,Chenzhou,Hunan 423000,China)

机构地区：[1]南方医科大学附属郴州医院,湘南学院第一附属医院,郴州市第一人民医院消化科,湖南郴州423000 [2]湘南学院附属医院老年综合内科,湖南郴州423000 [3]南方医科大学附属郴州医院,湘南学院第一附属医院,郴州市第一人民医院肿瘤内科,湖南郴州423000

出　　处：《中华生物医学工程杂志》2021年第3期282-287,共6页Chinese Journal of Biomedical Engineering

摘　　要：目的探讨肝硬化患者日常行为能力异常筛查可疑轻微肝性脑病的临床价值,分析肝硬化合并轻微肝性脑病的危险因素。方法收集2017年1月至2020年6月本院收治的肝硬化患者547例,均进行轻微肝性脑病诊断,采用疾病影响程度量表(SIP)评价患者日常行为能力。分析肝功能Child-Pugh分级与轻微肝性脑病的关系,比较轻微肝性脑病阳性与阴性患者的SIP评分,多因素Logistic回归分析肝硬化合并轻微肝性脑病的危险因素。结果肝硬化患者547例中轻微肝性脑病阳性154例,阳性率为28.15%。按肝功能Child-Pugh分级分组,Child-A级患者轻微肝性脑病阳性率为20.00%(27/135),Child-B级为23.81%(60/252),Child-C级为41.88%(67/160);Child-C级患者轻微肝性脑病阳性率显著高于Child-A级、Child-B级(均P<0.05)。轻微肝性脑病阳性与阴性患者的行走能力、情感行为、社交能力、生活自理能力、反应能力、睡眠障碍评分及总分组间比较,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,年龄(OR=1.659,95%CI:1.032~4.697)、Child-C级(OR=2.476,95%CI:1.379~3.965)、营养风险(OR=1.714,95%CI:1.135~2.568)、日常行为能力异常(OR=2.895,95%CI:1.059~4.351)、血氨浓度(OR=1.534,95%CI:1.041~2.627)、国际标准化比值(OR=2.105,95%CI:1.562~3.374)是肝硬化合并轻微肝性脑病的危险因素(均P<0.05)。结论肝硬化患者日常行为能力异常与轻微肝性脑病有关,筛查日常行为能力有助于发现可疑轻微肝性脑病患者。Objective To investigate the clinical value of screening for mild hepatic encephalopathy suspected in liver cirrhosis patients who develop disability in daily living activities,and to analyze the risk factors of complicating mild hepatic encephalopathy in liver cirrhosis.Methods A total of 547 patients with liver cirrhosis admitted to our hospital between January 2017 and June 2020 were included.All patients were evaluated for diagnosis of mild hepatic encephalopathy.The Sickness Impact Profile(SIP)scale was used to assess the daily living activities of the patients.The relationship between Child-Pugh classification of liver function and mild hepatic encephalopathy were determined.The SIP scores were compared between patients positive and negative for mild hepatic encephalopathy.The risk factors of complicating mild hepatic encephalopathy in liver cirrhosis were analyzed by multivariate Logistic regression.Results Of the 547 patients with liver cirrhosis,154 were positive for mild hepatic encephalopathy,with a positive rate of 28.15%.According to the Child-Pugh classification of liver function,the positive rate of mild hepatic encephalopathy was 20.00%(27/135)in Child-A patients,23.81%(60/252)in Child-B patients,and 41.88%(67/160)in Child-C patients.The positive rate of mild hepatic encephalopathy was significantly higher in Child-C patients compard with Child-A and Child-B patients(both P<0.05).There were statistically significant differences in scores of mobility,emotional behavior,social interaction,self-care,alertness,sleep disturbance and total scores of SIP between patients positive and negative for mild hepatic encephalopathy(all P<0.05).Multivariate Logistic regression analysis showed that age(OR=1.659,95%CI:1.032-4.697),Child-C grade(OR=2.476,95%CI:1.379-3.965),nutritional risk(OR=1.714,95%CI:1.135-2.568),disability in daily living activities(OR=2.895,95%CI:1.059-4.351),blood ammonia level(OR=1.534,95%CI:1.041-2.627),international normalized ratio(OR=2.105,95%CI:1.562-3.374)were risk factors for complica

关 键 词：肝硬化 肝性脑病 日常行为能力 疾病影响程度量表 危险因素 

分 类 号：R575.2[医药卫生—消化系统] R747.9[医药卫生—内科学]