乙型肝炎肝硬化失代偿期患者合并肝性脊髓病的临床特征分析  

Clinical characteristics of hepatitis B patients with decompensated cirrhosis combined with hepatic myelopathy

作　　者：李菊红 郝彦琴[2] 石敏 LI Ju-hong;HAO Yan-qin;SHI Min(Shanxi Medical University First Clinical Medical College,Taiyuan 030001,China;Department of Infectious Diseases,First Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第一临床医学院,太原030001 [2]山西医科大学第一医院感染病科

出　　处：《肝脏》2024年第6期687-690,共4页Chinese Hepatology

基　　金：山西省自然科学研究面上项目(202103021224241)。

摘　　要：目的 分析乙型肝炎肝硬化失代偿期患者合并肝性脊髓病的临床特征。方法 选择2018年4月至2023年4月山西医科大学第一医院收治的40例乙型肝炎肝硬化失代偿期合并肝性脊髓病患者作为观察组,选择同期未合并肝性脊髓病患者55例作为对照组。比较两组临床特征,采用多因素logistic回归分析乙型肝炎肝硬化失代偿期患者合并肝性脊髓病的独立危险因素。结果 观察组的总胆红素、AST、ALT和血氨水平分别为(40.5±24.8)μmol/L、(220.6±57.8)U/L、(253.5±66.4)U/L、(116.3±23.5)μmol/L,均高于对照组的(32.6±15.4)μmol/L、(120.5±58.2)U/L、(153.1±64.6)U/L、(72.6±13.8)μmol/L;观察组白蛋白、胆碱酯酶、凝血酶原时间活动度分别为(10.3±2.1)g/L、(2.1±0.8)U/L、(27.8±4.2)%,低于对照组的(12.1±2.2)g/L、(2.6±0.2)U/L、(31.6±6.8)%,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,乙型肝炎肝硬化失代偿期患者合并肝性脊髓病的危险因素为ALT、凝血酶原时间活动度、高血氨和低白蛋白(OR=0.382、4.568、4.166、0.401,P<0.05)。结论 ALT、凝血酶原时间活动度、高血氨、低白蛋白为独立危险因素。Objective To analyze clinical features of hepatitis B patients with decompensated cirrhosis combined with hepatic myelopathy.Methods Between April 2018 and April 2023,40 hepatitis B patients with decompensated cirrhosis and hepatic myelopathy were enrolled in this study as the observation group.A control group consisting of 55 hepatitis B patients with decompensated cirrhosis but without hepatic myelopathy was also selected from the same period.Clinical characteristics of both groups were compared,and independent risk factors for hepatic myelopathy in patients with decompensated cirrhosis were analyzed using multifactorial logistic regression.Results The levels of total bilirubin,glutathione,glutathione and serum ammonia in the observation group were(40.5±24.8)μmol/L,(220.6±57.8)U/L,(253.5±66.4)U/L,(116.3±23.5)μmol/L,respectively,which were higher than those in the control group[(32.6±15.4)μmol/L,(120.5±58.2)U/L,(153.1±64.6)U/L,(72.6±13.8)μmol/L].Conversely,albumin,cholinesterase,and prothrombin time activity in the observation group were(10.3±2.1)g/L,(2.1±0.8)U/L,and(27.8±4.2)%,respectively,which were significantly lower than those in the control group[(12.1±2.2)g/L,(2.6±0.2)U/L,(31.6±6.8)%,respectively,P<0.05].Multifactorial logistic regression analysis identified alanine aminotransferase,prothrombin time activity,high serum ammonia,and low albumin as independent risk factors for hepatic myelopathy in hepatitis B patients with decompensated cirrhosis(OR=0.382,4.568,4.166,0.401,P<0.05).Conclusion Albumin transaminase,prothrombin time activity,high blood ammonia,and low albumin are independent risk factors for hepatic myelopathy in patients with decompensated cirrhosis due to hepatitis B.

关 键 词：乙型肝炎 肝硬化失代偿 肝性脊髓病 临床特征 

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