重型肝炎/肝衰竭临床分类的进一步探讨

目的提高对重型肝炎，肝衰竭临床分类的进一步认识。方法回顾分析25l例急性、亚急性肝衰竭患者的临床资料，按照病因分为无肝病基础组（第l组）、肝炎组（第2组）、肝硬化组（第3组）共3组，并对每组中急性、亚急性肝衰竭的实验室检查、肝性脑病的发病率及预后进行统计学分析。结果（1）转氨酶、胆碱脂酶及白蛋白的差异：无论是急性还是亚急性肝衰竭中，无肝病基础组转氨酶、胆碱脂酶及白蛋白均明显高于有肝病基础患者，特别是高于肝硬化组患者（P〈0．05）；（2）肝性脑病的发病率及各等级分布：在l、2、3组中，急性肝衰竭肝性脑病的发病率分别为100．00％，66．23％和51．02％；亚急性肝衰竭分别为71．42％，54．81％和49．99％；（3）在预后方面：在1、2、3组中急性肝衰竭的好转治愈率分别为15．38％、42．85％和26．09％；亚急性肝衰竭患者33．33％、51．39％和36．85％，3组具有统计学差异（P〈0．05）。结论无论是急性还是亚急性发病，3组重型肝炎，肝衰竭患者的临床特点及其预后均有差异，依此进行分类，有其临床实用性及科学性，将能更好的指导临床诊断、治疗和预后判断。

To re-evaluate the clinical classification criteria of liver failure

OBJECTIVE: To study the clinical feature and more reasonable diagnostic typing criteria for patients with liver failure. METHODS: 13/21 cases of ALF, SALF with no past liver disease, 49/72 cases of with chronic hepatitis, and 23/73 cases ALF, SALF with liver cirrhosis, were analyzed respectively. RESULTS: 1 ALF patients (1). There exist significant statistic differences in ALB, ALT, CHE in three ALF groups.(2). It had statistic differences in those patients with hepatic encephalopathy.(3). The prognosis of the patients with chronic hepatitis group (42.85 percent) was best than that of chronic cirrhosis (26.09 percent) and no past liver disease (15.38 percent). (2) In SALF patients (1). There exist significant statistic differences in ALB, GLO, ALT, AST, BDIL, GLU and CHE in three SALF groups.(2). It had statistic differences in those patients with hepatic encephalopathy in three SALF groups.(3). The prognosis of the patients with chronic hepatitis group (51.39 percent) was best than that of chronic cirrhosis (36.85 percent) and no past liver disease (33.33 percent). CONCLUSION: There are different clinic feature and prognosis in three ALF or SALF groups, so we suggest that it were clinic practicability and science in classify of liver failure at present.