经人工肝支持系统治疗的慢加急性肝衰竭患者短期预后的危险因素分析  

Analysis of short-term prognostic risk factors of patients with chronic acute liver failure treated by artificial liver support system

作　　者：向艳萍 李自琼[2] 赵栩[3] 向春桔 XIANG Yanping;LI Ziqiong;ZHAO Xu;XIANG Chunju(Department of Infection,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Nursing,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Operating Room,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院感染科,重庆400016 [2]重庆医科大学附属第一医院护理部,重庆400016 [3]重庆医科大学附属第一医院手术室,重庆400016

出　　处：《检验医学与临床》2024年第10期1492-1496,1504,共6页Laboratory Medicine and Clinic

基　　金：重庆市重点专科建设《临床护理》精品建设项目[0203(2023)47号202336]。

摘　　要：目的观察人工肝支持系统(ALSS)治疗慢加急性肝衰竭(ACLF)患者的90 d生存情况,分析影响ALSS治疗ACLF患者90 d预后的危险因素。方法回顾性分析2019年8月至2023年8月该院感染科收治的212例ACLF患者临床资料,以患者入院时为起点,入院后90 d为随访终点,根据随访获得的生存情况分为生存组和死亡组,比较两组基线资料、实验室指标、相关并发症发生情况,采用多因素Logistic回归分析影响ALSS治疗ACLF患者90 d预后的危险因素。结果在90 d内,患者死亡70例,病死率为33.0%。死亡组年龄、肝性脑病发生率均高于生存组,差异均有统计学意义(P<0.05)。生存组总胆红素(TBIL)、凝血酶原时间(PT)、C反应蛋白(CRP)水平及入院时终末期肝病模型(MELD)评分明显低于死亡组,差异有统计学意义(P<0.05),而前清蛋白(PA)、凝血酶原活动度(PTA)、纤维蛋白原(FG)、甲胎蛋白(AFP)、钠(Na)水平明显高于死亡组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示:PA(OR=0.966,95%CI:0.935~0.999,P=0.042)、FG(OR=0.077,95%CI:0.016~0.377,P=0.002)水平降低,CRP(OR=1.055,95%CI=1.005~1.107,P=0.030)、MELD评分(OR=2.146,95%CI:1.632~2.822,P<0.001)升高,合并肝性脑病(OR=7.185,95%CI:1.607~32.116,P=0.010)为ALSS治疗ACLF患者90 d内死亡的独立危险因素(P<0.05)。结论PA、FG、CRP、MELD评分、合并肝性脑病均为影响ALSS治疗ACLF患者90 d内死亡的独立危险因素,临床应加强观察,积极防治并发症。Objective To observe the 90 d survival of patients with chronic acute liver failure(ACLF)treated with artificial liver support system(ALSS),and analyze the risk factors affecting the 90 d prognosis of patients with ACLF treated with ALSS.Methods The clinical data of 212 patients with ACLF admitted to the Department of Infection of the First Affiliated Hospital of Chongqing Medical University from August 2019 to August 2023 were analyzed retrospectively.The patients were followed up at the time of admission and 90 days after admission.The patients were divided into survival group and death group according to the survival status obtained by follow-up.The baseline general data,laboratory indicators and related complications of the two groups were compared.The risk factors affecting the 90 day prognosis of ACLF patients treated with ALSS were analyzed by multivariate Logistic regression.Results Seventy patients died within 90 days,with a mortality rate of 33.0%.The age and incidence rate of hepatic encephalopathy in the death group were higher than those in the survival group,the differences were statistically significant(P<0.05).The levels of total bilirubin(TBIL),prothrombin time(PT),C-reactive protein(CRP),model for end-stage liver disease at admission(MELD)score in the survival group were significantly lower than those in the death group(P<0.05),while the levels of prealbumin(PA),prothrombin activity(PTA),fibrinogen(FG),alpha-fetoprotein(AFP),sodium(Na)in the survival group were significantly higher than those in the death group(P<0.05).Multivariate Logistic regression analysis showed that increased PA(OR=0.966,95%CI:0.935—0.999,P=0.042),FG(OR=0.077,95%CI:0.016—0.377,P=0.002),CRP(OR=1.055,95%CI=1.005—1.107,P=0.030)and MELD score(OR=2.146,95%CI:1.632—2.822,P<0.001),hepatic encephalopathy(OR=7.185,95%CI:1.607—32.116,P=0.010)were independent risk factors affecting the 90 day prognosis of ACLF patients treated with ALSS(P<0.05).Conclusion PA,FG,CRP,MELD score and hepatic encephalopathy were all independent

关 键 词：慢加急性肝衰竭 预后 影响因素 人工肝 肝性脑病 

分 类 号：R575.3[医药卫生—消化系统]