130例酒精性肝衰竭患者临床特点与预后分析

目的：分析酒精性肝衰竭患者临床特点及预后影响因素。方法回顾性分析2004年1月至2013年5月住解放军第302医院的资料完整的130例酒精性肝衰竭患者的临床特点及预后影响因素。结果酒精性肝衰竭患者的诱发因素为感染（52.3%）、短期过度饮酒（8.5%）、疲劳（3.8%）、情绪激动（0.8%），另有34.6%原因不明；酒精性肝衰竭患者治愈或好转率为41.5%，无效率为42.3%，死亡率为16.1%，其中死亡前4位的原因分别为肝性脑病和脑水肿或脑疝（33.3%）、感染性休克（28.6%）、失血性休克（23.8%）和肝肾综合征（9.5%）；无效或死亡患者脑水肿、脑疝和肝肾综合征的发生率分别为14%、7%和36%，显著高于治愈或好转患者[分别为1%、1%和6%，P 均〈0.01）]；无效或死亡患者血红蛋白水平[（85.0±28.3） g/L]显著低于治愈或好转组[（95.2±27.6）g/L，P〈0.05）]；无效或死亡患者 Maddrey 判别函数、MELD 评分和 Glasgow 评分分别为（94.56±63.17）、（25.52±8.29）和（9.76±1.04），均显著高于治愈或好转患者[分别为（68.24±24.61）、（19.03±10.13）和（9.30±1.11），P 均〈0.01）]；凝血酶原时间（r=-0.19， P=0.03）、国际标准化比值（r=-0.21，P=0.02）、尿素氮（r=-0.28，P=0.01）和肌酐（r=-0.28，P=0.01）水平与预后均呈负相关关系（P〈0.05或 P〈0.01），患者出现脑水肿（r=-0.26，P=0.01）、脑疝（r=-0.26，P=0.01）和肝肾综合征（r=-0.38， P=0.01）均与预后呈负相关（P〈0.01）。结论酒精性肝衰竭的常见诱发因素为感染和短期过量饮酒，凝血功能、肾功能和脑功能障碍是预后不良的重要预测因素。

Clinical features and prognosis in 130 patients with alcoholic liver failure

Objective To investigate the clinical features and prognosis of patients with alcoholic liver fail-ure. Methods The clinical features and prognosis in 130 patients with alcoholic liver failure who had admitted to Beijing 302nd Hospital of PLA from January 2004 to May 2013 were retrospectively analyzed. Results The precipitating factors of patients with alcoholic liver failure were concurrent infection （52.3%）,short-term excessive drinking（8.5%）,fatigue（3.8%）,emotional change（0.8%） and unknown cause（34.6%）; The curative or improve-ment rate of patients with alcoholic liver failure was 41.5%,the nonresponsive to treatment was 42.3%,and the mortality rate was 16.2%;Hepatic encephalopathy and cerebral edema or cerebral hernia （33.3%）,septic shock （28.6%）,hemorrhagic shock（23.8%） and hepatorenal syndrome（9.5%） were the top four causes of death;The in-cidence of cerebral edema,cerebral hernia,hepatorenal syndrome in nonresponsive or death patients were 14%,7%and 36% respectively,significantly higher than those in improved patients （1%,1% and 6%,respectively,P〈0.01）;The blood hemoglobin levels in nonresponsive or death patients [（85.0± 28.3）g/L]was significantly lower than that in improved patients [（95.2 ±27.6） g/L,P 〈0.05];The Maddrey＇s discriminant function,MELD score and Glasgow score in nonresponsive or death patients were（94.56±63.17）,（25.52±8.29）and（9.76±1.04）,respectively,significantly higher than those in improved patients [（68.24±24.61）,（19.03±10.13）and （9.30±1.11）,P〈0.01];Prothrombin time （r=-0.19,P=0.03）,international normalized ratio（r=-0.21,P=0.02）,blood urea nitrogen（r=-0.28,P=0.01） and cre-atinine（r=-0.28,P=0.01） were negatively correlated with the prognosis of patients（P〈0.05 or P〈0.01）;Patients with cerebral edema （r=-0.26,P=0.01）,cerebral hernia （r=-0.26,P=0.01） and hepatorenal syndrome （r=-0.38,P=0.01）were negatively correlated with the prognosis（P〈0.01）. Conclusions The common precipitating factors of patients with alcoholic liver failure are concurrent infection and short-term excessive drinking. Coagulation, kidney and brain dysfunction are important predictors for poor prognosis.