不同类型肝衰竭临床特点及其转归相关危险因素分析

目的了解不同类型肝衰竭的临床特点及其预后相关因素。方法收集1991—2006年问本院收治的437例各型肝衰竭，对其临床特点及影响转归的相关因素进行探讨分析。结果不同类型肝衰竭的转归差异显著，急性肝衰竭和慢性肝衰竭差异较大，亚急性肝衰竭和慢性肝衰竭预后差异较小。年龄、总胆红素、凝血酶原活动度（PTA）、肝性脑病、消化道出血、合并感染、肝肾综合征等并发症是影响患者最后结果的关键临床因素。乙型肝炎病毒仍然是各型肝衰竭的最常见原因。急性肝衰竭比亚急性，慢性肝衰竭肝性脑病发生率明显增高，各型肝衰竭的最常见并发症分别是肝性脑病和腹水。结论急性、亚急性、慢性肝衰竭的病因差异较大，各型肝衰竭的预后不同。肝性脑病是急性肝衰竭最常见并发症，而腹水是亚急性和慢性肝衰竭的最主要并发症。PTA和胆红素等仍然是各型肝衰竭判断预后简单而又重要的特异性指标，在亚急性和慢性肝衰竭中尤为重要。

Analysis of clinical characteristics and related factors affecting the prognosis of varies liver failure

Objective To undersdand varies liver failure through analyzing the clinical characteristics and related factors affecting the prognosis. Methods 437 cases with varies liver failure treated in YiJishan Hospital of Wannan Medical Colleage from 1991 to 2006 were analyzed through the clinical characteristics and related factors affecting the prognosis. Results There were significant differences between the prognosis of acute liver failure （ASH） and chronic liver failure （CSH） . While there was a small difference between subacute liver failure （SSH） and CSH. There were many key factors ,affecting the prognosis of liver failure, such as age, total bilirubin （TBil）, prothrombin activity （PTA） , hepatic encephalopathy （HE）, gastrointestinal bleeding, complicated by infection, hepatitic -renal syndrome（HRS）. HBV was one of the most dominating factors. Hepatic encephalopathy is more easily occured in acute liver failure （ASH）. The most common complications of varies liver failure were HE and ascites. Conclusion The prognosis were different in ASH , SSH, and CSH . HE was the most common complication of ASH. ascites was the most common complication of CSH and SSH. The indexes, such as PTA, TBil were important sensitivity and specificity for the prognosis of liver failure, especially for patients with SSH or CSH.