失代偿期肝硬化合并肝性胸水临床特点及危险因素分析  

Clinical features and risk factors of decompensated liver cirrhosis with hepatic hydrothorax

作　　者：张丽娜[1] 马治国 马伟芳 杨少奇[1] 谢晓华[1] ZHANG Li-na;MA Zhi-guo;MA Wei-fang;YANG Shao-qi;XIE Xiao-hua(Department of Gastroenterology,General Hospital of Ningxia Medical University,Yinchuan 750003,China;不详)

机构地区：[1]宁夏医科大学总医院,宁夏回族自治区银川750003 [2]银川市中医医院,宁夏回族自治区银川750010 [3]宁夏医科大学临床医学院,宁夏回族自治区银川750004

出　　处：《中国实用内科杂志》2023年第7期578-582,共5页Chinese Journal of Practical Internal Medicine

基　　金：宁夏自然科学基金项目(2021AAC03342);宁夏医科大学校级项目(XM2021046)。

摘　　要：目的分析肝硬化合并肝性胸水的临床特点及发生肝性胸水的危险因素。方法收集宁夏医科大学总医院2011年1月至2020年12日肝硬化住院患者的病例资料,将符合纳入标准的177例肝性胸水的患者病例作为研究组,未合并肝性胸水的1030例作为对照组,比较两组患者病历资料,分析肝性胸水的临床特点及发生肝性胸水的危险因素。结果肝性胸水以右侧胸腔多见(80.23%),胸水性质主要为漏出液(94.92%);呼吸困难和腹胀是肝性胸水的最常见的临床表现,分别占55.37%和41.24%;肝性胸水治疗主要以利尿和单次胸腔穿刺置管引流为主(80.23%),多数患者治疗后胸水消退(98.31%)。肝性胸水组合并腹水、食管胃底静脉曲张、门静脉血栓、肝功能Child-Pugh评分、MELD评分均高于对照组,血清白蛋白低于对照组,两组比较具有统计学差异(P<0.05)。多因素logistic分析显示腹水(OR 2.759,95%CI 1.252~6.080)、白蛋白<30 g(OR 2.582,95%CI 1.145~5.821)、门静脉血栓形成(OR 3.385,95%CI 1.319~6.954)是发生肝性胸水的危险因素(P<0.05)。结论腹水、白蛋白<30 g、门静脉血栓形成是发生肝性胸水的危险因素。Objective To summarized the clinical features andanalyze risk factors of decompensated liver cirrhosis with hepatic hydrothorax.Methods A retrospective study was conducted of patients with decompensated liver cirrhosis in the General Hospital of Ningxia Medical University between Jan.2011 and Dec 2020.According to inclusion criteria,among of 177 patients with hepatic hydrothorax were selected as the study group,and 1030 patients without hepatic hydrothorax were selected as the control group.Tosummarize the clinical characteristics and analyze risk factors of hepatic hydrothorax.Results Hepatic hydrothorax was more common in the right thoracic cavity(80.23%).The pleural fluid was mainly transudate(94.92%).Dyspnea and abdominal distension were the most common clinical manifestations of hepatic hydrothorax,accounting for 55.37%and 41.24%respectively.Hepatic hydrothorax was mainly treated with diuresis and single pleural puncture(80.23%),and the hydrothorax subsided after treatment in most patients(98.31%).Compared with the control group,the incidence of ascites,esophagogastric varices,portal vein thrombosis,Child-Pugh score and MELD score were higher than the control group,the serum albumin was lower than the control group,the comparison between the two groups was statistically significant(P<0.05).Multivariate logistic regression analysis showed ascites(OR 2.759,95%CI 1.252-6.080,P=0.012),albumin<30g(OR 2.582,95%CI 1.145-5.821,P=0.022)and portal vein thrombosis(OR 3.385,95%CI 1.319-6.954,P=0.026)were risk factors for hepatic hydrothorax.Conclusion Ascites,albumin<30g and portal vein thrombosis were risk factors for hepatic hydrothorax.

关 键 词：肝硬化 肝性胸水 临床特点 危险因素 

分 类 号：R575.2[医药卫生—消化系统] R561.3[医药卫生—内科学]