失代偿期乙型肝炎肝硬化并发肝性脑病患者30天内死亡影响因素分析  

Influencing factors for death within 30 days in patients with decompensated hepatitis B cirrhosis and hepatic encephalopathy

作　　者：黄云义 时克 王宪波[2] HUANG Yunyi;SHI Ke;WANG Xianbo(Department of Traditional Chinese Medicine,Nanyang Central Hospital,Nanyang,Henan 473000,China;Center of Integrated Traditional Chinese and Western Medicine,Beijing Ditan Hospital,Beijing 100015,China)

机构地区：[1]南阳市中心医院中医科,河南南阳473000 [2]北京地坛医院中西医结合中心,北京100015

出　　处：《临床肝胆病杂志》2024年第3期516-520,共5页Journal of Clinical Hepatology

基　　金：国家中医药管理局高水平中医药重点学科建设项目(zyyzdxk-2023005)。

摘　　要：目的 探讨乙型肝炎肝硬化失代偿期并发肝性脑病患者30天内死亡的影响因素。方法 回顾性收集2008年1月—2018年4月北京地坛医院乙型肝炎肝硬化并发肝性脑病患者616例,随访观察30天,根据患者预后将其分为生存组(n=488)与死亡组(n=128)。计量资料两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ^(2)检验或Fisher精确检验。采用Cox回归分析探讨乙型肝炎肝硬化并发肝性脑病患者30天内死亡的独立危险因素。结果 Cox多因素回归分析显示,年龄(HR=1.029,95%CI:1.014~1.044,P<0.001)、MELD评分(HR=1.118,95%CI:1.098~1.139,P<0.001)及中性粒细胞与淋巴细胞比值(NLR)(HR=1.036,95%CI:1.015~1.057,P=0.001)是乙型肝炎肝硬化并发肝性脑病患者30天内死亡的独立危险因素。分层分析显示,当MELD评分≥20分与NLR≥4时,患者死亡风险较高,30天内的病死率为57.1%(80/140);MELD评分<20分与NLR<4时,30天内的病死率为3.9%(9/232)。结论 年龄、MELD评分及NLR是影响乙型肝炎肝硬化并发肝性脑病患者30天内死亡的独立危险因素,MELD评分≥20分与NLR≥4的患者30天内的死亡风险较高。Objective To investigate the influencing factors for death within 30 days in patients with decompensated hepatitis B cirrhosis and hepatic encephalopathy.Methods A retrospective analysis was performed for 616 patients with hepatitis B cirrhosis and hepatic encephalopathy in Beijing Ditan Hospital from January 2008 to April 2018,and all patients were followed up for 30 days.According to their prognosis,they were divided into survival group with 488 patients and death group with 128 patients.The Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups.The Cox regression analysis was used to investigate the independent risk factors for death within 30 days in patients with hepatitis B cirrhosis and hepatic encephalopathy.Results The multivariate Cox regression analysis showed that age(hazard ratio[HR]=1.029,95%confidence interval[CI]:1.014—1.044,P<0.001),Model for End-Stage Liver Disease(MELD)score(HR=1.118,95%CI:1.098—1.139,P<0.001),and neutrophil-to-lymphocyte ratio(NLR)(HR=1.036,95%CI:1.015—1.057,P=0.001)were independent risk factors for death within 30 days in patients with hepatitis B cirrhosis and hepatic encephalopathy.The stratified analysis showed that the patients with a MELD score of≥20 and an NLR of≥4 had a higher risk of death,with a 30-day mortality rate of 57.1%(80/140).The patients with a MELD score of<20 and an NLR of<4 had a 30-day mortality rate of 3.9%(9/232).Conclusion Age,MELD score,and NLR are independent risk factors for death within 30 days in patients with hepatitis B cirrhosis and hepatic encephalopathy,and patients with a MELD score of≥20 and an NLR of≥4 tend to have a high risk of death.

关 键 词：乙型肝炎 肝硬化 肝性脑病 预后 危险因素 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学] R747.9