106例慢加急性肝衰竭合并肝性脑病患者预后影响因素的Logistic回归分析

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(P0.05)。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。

Logistic regression analysis of prognostic factors in 106 acute -on -chronic liver failure patients with hepatic enceph-alopathy

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.