肝硬化腹水患者30d再住院和3年病死的危险因素分析  

Risk factors of 30 days readmission and 3 years mortality of patients with liver cirrhosis and ascites

作　　者：王征[1] 侯维[1] 王克菲[1] 张维[1] 刘晓慧[2] 于红卫[3] 胡中杰[1] Wang Zheng;Hou Wei;Wang Kefei;Zhang Wei;Liu Xiaohui;Yu Hongwei;Hu Zhongjie(The First Department of Liver Disease Center,Beijing YouAn Hospital,Capital Medical University,Beijing 100069,China;The Third Department of Liver Disease Center,Beijing YouAn Hospital,Capital Medical University,Beijing 100069,China;The Outpatient Department,Beijing YouAn Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院肝病中心一科,北京100069 [2]首都医科大学附属北京佑安医院肝病中心三科,北京100069 [3]首都医科大学附属北京佑安医院门诊中心,北京100069

出　　处：《中国肝脏病杂志（电子版）》2021年第3期16-24,共9页Chinese Journal of Liver Diseases：Electronic Version

基　　金：北京市肝病研究所/改革与发展-院所合作项目(Y-2020HZ-2);青海省重点研发与转化计划(2017-SF-159)。

摘　　要：目的探讨影响肝硬化腹水患者30 d再住院和3年病死率的相关危险因素。方法以2016年7月1日至2017年7月1日首都医科大学附属北京佑安医院收治的386例肝硬化腹水住院患者为研究对象,根据30 d再住院情况分为30 d再住院组(40例)和非30 d再住院组(346例);根据3年生存情况分为存活组(332例)和病死组(54例)。观察指标包括患者的一般资料、临床特点、基础疾病、并发症、Child Turcotte Pugh(CTP)分级、终末期肝病模型(model for end-stage liver disease,MELD)评分、住院时间、白细胞计数(white blood cell,WBC)、中性粒细胞计数(neutrophil,NEUT)、淋巴细胞计数(lymphocyte,LYM)、血红蛋白(hemoglobin,HGB)、血小板(platelet,PLT)、总胆红素(total bilirubin,TBil)、白蛋白(albumin,ALB)、血肌酐(creatinine,Cr)、腹水白细胞、腹水多核细胞(polymorphonuclear,PMN)、C-反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)及国际标准化比率(international normalized ratio,INR)等。采用多因素Logistic回归分析肝硬化腹水患者出院后30 d再住院的危险因素,采用Cox风险回归分析患者3年病死的危险因素。结果386例肝硬化腹水患者中有40例(10.4%)患者出院后30 d再次住院,再住院的最主要原因是不同部位感染[19/40(47.5%)]。所有患者中共有54例患者3年内病死,3年病死率为14.0%。30 d再住院组患者年龄[(61.25±9.48)岁vs(57.06±12.15)岁;t=-2.106,P=0.036]、住院期间发生上消化道出血的比例(32.5%vs 19.1%;χ^(2)=3.970,P=0.046)、血WBC(中位数:6.12×10^(9)/L vs 3.94×10^(9)/L;U=-3.193,P=0.001)和NEUT(中位数:4.22×10^(9)/L vs 2.72×10^(9)/L;U=-2.789,P=0.005)均显著高于非30 d再住院组患者,LYM显著低于非30 d内再住院组患者(中位数:0.53×10^(9)/L vs 0.86×10^(9)/L;U=-3.936,P<0.001),其他指标差异无统计学意义(P均>0.05)。病死组患者年龄[(63.20±10.88)岁vs(56.56±11.89)岁;t=-3.847,P<0.001]、SBP比例(42.6%vs 27.7%;χ^(2)=4.918,P=0.027Objective To investigate the risk factors of 30 days readmission and 3 years mortality of patients with liver cirrhosis and ascites.Methods A total of 386 hospitalized patients with liver cirrhosis and ascites in Beijing YouAn Hospital,Capital Medical University from July 1st,2016 to July 1st,2017 were selected as the research objects.According to readmission within 30 days or not,the patients were divided into 30 days readmission group(40 cases)and non 30 days readmission group(346 cases);according to 3 years survival situation,the patients were divided into survival group(332 cases)and death group(54 cases).The observation indexes included general data,clinical characteristics,basic diseases,complications,Child Turcotte Pugh(CTP)grade,model for end-stage liver disease(MELD)score,length of stay,white blood cell(WBC),neutrophil(NEUT),lymphocyte(LYM),hemoglobin(HGB),platelet(PLT),total bilirubin(TBil),albumin(ALB),creatinine(Cr),ascites leukocytes,ascites polymorphonuclear(PMN),C-reactive protein(CRP),procalcitonin(PCT)and international normalized ratio(INR).Risk factors for 30 days readmission of patients with liver cirrhosis and ascites were analyzed by multivariate Logistic regression.Risk factors for 3 years mortality of patients with liver cirrhosis and ascites were analyzed by Cox risk regression analysis.Results Out of the 386 patients with liver cirrhosis and ascites,a total of 40 patients(10.4%)were readmitted within 30 days after discharge.The main cause of readmission was infection at different sites(47.5%).A total of 54 patients died within 3 years,and the 3 years mortality was 14.0%.Age[(61.25±9.48)years vs(57.06±12.15)years;t=-2.106,P=0.036],the proportion of upper gastrointestinal bleeding occurring during hospitalization(32.5%vs 19.1%;χ^(2)=3.970,P=0.046),WBC(median:6.12×10^(9)/L vs 3.94×10^(9)/L;U=-3.193,P=0.001)and NEUT(median:4.22×10^(9)/L vs 2.72×10^(9)/L;U=-2.789,P=0.005)of patients in 30 days readmission group were significantly higher than those in non 30 days readmission group,LYM(me

关 键 词：肝硬化 腹水 预后 危险因素 

分 类 号：R575.2[医药卫生—消化系统]