临床肝胆病杂志
臨床肝膽病雜誌
림상간담병잡지
CHINESE JOURNAL OF CLINICAL HEPATOLOGY
2014年
10期
992-995
,共4页
崔燕平%刘凤华%石庆凤%赵洪奎%王思奎
崔燕平%劉鳳華%石慶鳳%趙洪奎%王思奎
최연평%류봉화%석경봉%조홍규%왕사규
肝功能衰竭%肝性脑病%Logistic 模型
肝功能衰竭%肝性腦病%Logistic 模型
간공능쇠갈%간성뇌병%Logistic 모형
liver failure%hepatic encephalopathy%logistic models
目的：对影响慢加急性肝衰竭（ACLF）伴肝性脑病（HE）患者预后的因素进行分析，探讨影响预后的危险因素。方法回顾性分析2010年1月-2013年7月在聊城市人民医院住院的106例 ACLF 伴 HE 患者的临床资料，分为好转组（n ＝15）和恶化组（n ＝91），将两组患者的单因素指标：年龄、性别、实验室指标[TBil、Alb、ALT、AST、凝血酶原活动度（PTA）]、HE 分期及并发症[持续性低钠血症、消化道出血、肝肾综合征（HRS）、腹水、感染、自发性细菌性腹膜炎（SBP）]、血浆置换进行χ2检验或 t 检验，再将有意义的单因素进一步行 Logistic 回归分析。结果单因素分析显示，ALT、PTA、HE 分期、HRS 差异有统计学意义（P 值分别为0.009、0．043、0．000、0．003）；性别、年龄、持续低钠血症、消化道出血、感染、SBP、腹水、TBil、Alb、AST、血浆置换差异无统计学意义（P ＞0．05）。经二元 Logistic 回归分析得出，PTA、HRS 、HE 分期对 ACLF 伴 HE 患者的预后有意义，回归系数分别为-0．097、2.279、1．873，P 值分别为0．025、0．007、0．000，优势比（OR 值）分别为0．908、6．510、9．764。结论HE 分期、HRS、PTA 是 ACLF 伴HE 预后的独立危险因素，PTA 越低、HE 分期越高，出现 HRS 时预后越差。
目的：對影響慢加急性肝衰竭（ACLF）伴肝性腦病（HE）患者預後的因素進行分析，探討影響預後的危險因素。方法迴顧性分析2010年1月-2013年7月在聊城市人民醫院住院的106例 ACLF 伴 HE 患者的臨床資料，分為好轉組（n ＝15）和噁化組（n ＝91），將兩組患者的單因素指標：年齡、性彆、實驗室指標[TBil、Alb、ALT、AST、凝血酶原活動度（PTA）]、HE 分期及併髮癥[持續性低鈉血癥、消化道齣血、肝腎綜閤徵（HRS）、腹水、感染、自髮性細菌性腹膜炎（SBP）]、血漿置換進行χ2檢驗或 t 檢驗，再將有意義的單因素進一步行 Logistic 迴歸分析。結果單因素分析顯示，ALT、PTA、HE 分期、HRS 差異有統計學意義（P 值分彆為0.009、0．043、0．000、0．003）；性彆、年齡、持續低鈉血癥、消化道齣血、感染、SBP、腹水、TBil、Alb、AST、血漿置換差異無統計學意義（P ＞0．05）。經二元 Logistic 迴歸分析得齣，PTA、HRS 、HE 分期對 ACLF 伴 HE 患者的預後有意義，迴歸繫數分彆為-0．097、2.279、1．873，P 值分彆為0．025、0．007、0．000，優勢比（OR 值）分彆為0．908、6．510、9．764。結論HE 分期、HRS、PTA 是 ACLF 伴HE 預後的獨立危險因素，PTA 越低、HE 分期越高，齣現 HRS 時預後越差。
목적：대영향만가급성간쇠갈（ACLF）반간성뇌병（HE）환자예후적인소진행분석，탐토영향예후적위험인소。방법회고성분석2010년1월-2013년7월재료성시인민의원주원적106례 ACLF 반 HE 환자적림상자료，분위호전조（n ＝15）화악화조（n ＝91），장량조환자적단인소지표：년령、성별、실험실지표[TBil、Alb、ALT、AST、응혈매원활동도（PTA）]、HE 분기급병발증[지속성저납혈증、소화도출혈、간신종합정（HRS）、복수、감염、자발성세균성복막염（SBP）]、혈장치환진행χ2검험혹 t 검험，재장유의의적단인소진일보행 Logistic 회귀분석。결과단인소분석현시，ALT、PTA、HE 분기、HRS 차이유통계학의의（P 치분별위0.009、0．043、0．000、0．003）；성별、년령、지속저납혈증、소화도출혈、감염、SBP、복수、TBil、Alb、AST、혈장치환차이무통계학의의（P ＞0．05）。경이원 Logistic 회귀분석득출，PTA、HRS 、HE 분기대 ACLF 반 HE 환자적예후유의의，회귀계수분별위-0．097、2.279、1．873，P 치분별위0．025、0．007、0．000，우세비（OR 치）분별위0．908、6．510、9．764。결론HE 분기、HRS、PTA 시 ACLF 반HE 예후적독립위험인소，PTA 월저、HE 분기월고，출현 HRS 시예후월차。
Objective To analyze the prognostic factors in acute -on -chronic liver failure (ACLF)patients with hepatic encephalopathy (HE)and to explore the risk factors for prognosis.Methods A retrospective analysis was performed on 106 ACLF patients with HE who were hospitalized in our hospital from January 2010 to July 2013.The patients were divided into improved group and deteriorated group.The univari-ate indicators including age,sex,laboratory indicators [total bilirubin (TBil),albumin (Alb),alanine aminotransferase (ALT),aspartate a-mino -transferase (AST),and prothrombin time activity (PTA)],the stage of HE,complications [persistent hyponatremia,digestive tract bleeding,hepatorenal syndrome (HRS),ascites,infection,and spontaneous bacterial peritonitis (SBP)],and plasma exchange were analyzed by chi -square test or t -test.Indicators with statistical significance were subsequently analyzed by binary logistic regression.Results Univa-riate analysis showed that ALT (P =0.009),PTA (P =0.043),the stage of HE (P =0.000),and HRS (P =0.003)were significantly dif-ferent between the two groups,whereas differences in age,sex,TBil,Alb,AST,persistent hyponatremia,digestive tract bleeding,ascites, infection,SBP,and plasma exchange were not statistically significant (P >0.05).Binary logistic regression demonstrated that PTA (b =-0.097, P =0.025,OR =0.908),HRS (b =2.279,P =0.007,OR =9.764),and the stage of HE (b =1.873,P =0.000,OR =6.510)were prognostic factors in ACLF patients with HE.Conclusion The stage of HE,HRS,and PTA are independent influential factors for the prognosis in ACLF pa-tients with HE.Reduced PTA,advanced HE stage,and the presence of HRS indicate worse prognosis.
