影响非生物型人工肝治疗急性肝衰竭患儿预后的危险因素分析  

Risk factors analysis of the prognosis influence for children with acute liver failure treated by non-biological artificial liver

作　　者：赵劭懂[1] 葛许华[1] 时珺[1] 缪红军[1] 周兆群 Zhao Shaodong;Ge Xuhua;Shi Jun;Miao Hongjun;Zhou Zhaoqun(Department of Pediatrics Intensive Care Unit,Children's Hospital of Nanjing Medical University,Nanjing 210008 Jiangsu,China)

机构地区：[1]南京医科大学附属儿童医院重症医学科,江苏南京210008

出　　处：《中国中西医结合急救杂志》2023年第2期180-184,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的分析应用非生物型人工肝(NBAL)治疗儿童急性肝衰竭(PALF)的临床特点及影响患儿预后的危险因素,为临床诊治和预后判断提供依据.方法采用回顾性研究方法,选择南京医科大学附属儿童医院2015年1月至2019年12月在儿科重症监护病房(PICU)应用NBAL治疗的PALF患儿的临床资料,包括性别、年龄、体质量、发热、呕吐、黄疸、萎靡、腹水、肝性脑病、外周血白细胞计数(WBC)、血红蛋白(Hb)、血小板计数(PLT)、降钙素原(PCT)、凝血酶原活动度(PTA)、凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、凝血酶时间(TT)、总胆红素(TBil)、直接胆红素(DBil)、间接胆红素(IBil)、DBil/TBil、DBil/IBil、血肌酐(SCr)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、血氨(SA)、甲胎蛋白(AFP)、血清白蛋白(ALB)、前白蛋白(PAB).采用单因素和多因素Logistic回归方法分析影响PALF行NBAL治疗患儿预后的危险因素,并绘制受试者工作特征曲线(ROC曲线)分析各危险因素对患儿预后的预测价值.结果研究共纳入113例患儿,存活74例,死亡39例.单因素分析显示,与存活组比较,死亡组年龄更小(岁:29.56±19.78比45.70±31.14),体质量更轻(kg:13.16±7.26比17.37±9.33),黄疸和肝性脑病发生率及WBC、PT、INR、APTT、TT、TBil、DBil、IBil、SA水平均更高[黄疸:46.15%(18/39)比25.68%(19/74),肝性脑病:56.41%(22/39)比36.49%(27/74),WBC(×10^(9)/L):19.30±5.89比12.85±3.26,PT(s):29.14±14.32比20.15±9.38,INR:3.44±1.15比1.75±0.81,APTT(s):87.59±20.75比43.54±12.22,TT(s):28.50±6.99比20.71±5.88,TBil(μmol/L):719.77±109.19比176.46±68.52,DBil(μmol/L):409.61±89.96比123.66±52.24,IBil(μmol/L):290.56±45.45比52.67±18.03,SA(μmol/L):356.92±72.29比73.31±43.28,均P<0.05],Hb、PLT、PTA、Fib、DBil/TBil、DBil/IBil、ALB、PAB均明显降低[Hb(g/L):72.33±28.91比91.98±37.02,PLT(×10^(9)/L):50.82±26.38比114.88±54.21,PTA:0.3Objective To investigate the clinical characteristics and risk factors of pediatric acute liver failure(PALF)treated by non-biological artificial liver(NABL),and to provide the basis for clinical diagnosis and prognosis.Methods A retrospective study was conducted to select clinical data of children with PALF treated with NBAL in the pediatric intensive care unit(PICU)of Children's Hospital of Nanjing Medical University from January 2015 to December 2019,including gender,age,weight,fever,vomiting,jaundice,malaise,ascites,hepatic encephalopathy,peripheral blood white blood cell count(WBC),hemoglobin(Hb),platelet count(PLT),procalcitonin(PCT),prothrombin activity(PTA),prothrombin time(PT),international normalized ratio(INR),activated partial thromboplastin time(APTT),fibrinogen(Fib),thrombin time(TT),total bilirubin(TBil),direct bilirubin(DBil),indirect bilirubin(IBil),DBil/TBil,DBil/IBil,serum creatinine(SCr),alanine aminotransferase(ALT),aspartate aminotransferase(AST),serum ammonia(SA),alpha fetoprotein(AFP),albumin(ALB)and prealbumin(PAB).The risk factors affecting the prognosis of children treated with NBAL for PALF were analyzed by univariate and multivariable Logistic regression methods,and the predictive value of each factor on the prognosis of children was analyzed by drawing receiver operator characteristic curves(ROC curve).Results A total of 113 samples were included in the study,of whom 74 cases survived and 39 died.Univariate analysis showed that the deceased group was younger(age:29.56±19.78 vs.45.70±31.14)and lighter(kg:13.16±7.26 vs.17.37±9.33),the incidence of jaundice and hepatic encephalopathy and WBC,PT,INR,APTT,TT,TBil,DBil,IBil,SA levels were higher[jaundice:46.15%(18/39)vs.25.68%(19/74),hepatic encephalopathy:56.41%(22/39)vs.36.49%(27/74),WBC(×10^(9)/L):19.30±5.89 vs.12.85±3.26,PT(s):29.14±14.32 vs.20.15±9.38,INR:3.44±1.15 vs.1.75±0.81,APTT(s):87.59±20.75 vs.43.54±12.22,TT(s):28.50±6.99 vs.20.71±5.88,TBil(μmol/L):719.77±109.19 vs.176.46±68.52.DBil(μmol/L):409.61±89.96 vs.1

关 键 词：急性肝衰竭 非生物型人工肝 预后 儿科 

分 类 号：R575.3[医药卫生—消化系统]