影响妊娠合并重型肝炎预后的临床多因素分析

目的探讨影响妊娠合并重型肝炎患者预后的因素。方法通过回顾性研究中山大学附属第三医院1993年7月至2006年12月有完整资料的60例妊娠合并重型肝炎患者的临床资料，进行单因素和多因素分析，应用Logistic回归分析影响预后的主要因素。结果单因素分析显示急性重型肝炎、阴道分娩、白细胞总数（WBC）〉20×10^9／L、血清总胆红素（TBIL）〉350μmol／L、总胆固醇（CHOL）≤2．9mmol／L、钙离子（Ca^2＋）≤2.03mmol／L、钠离子（Na^＋）≤136mmol／L、空腹血糖（FPG）〈2．8mmol／L、凝血酶原活动度（PTA）≤20％、甲胎蛋白（AFP）≤300μg／L、酶．胆分离、肝性脑病、消化道出血、肝肾综合征等因素与不良预后相关（均P〈0．05）。多因素分析显示临床亚型、PTA、FPG和TBIL四个因素是影响预后的主要因素。结论TBIL〉350μmol／L、PTA≤20％、FPG〈2．8mmol／L提示妊娠合并重型肝炎预后不良，急性重型肝炎预后极差，值得临床工作者高度重视。

Multivariate analysis of prognostic factors for fulminant hepatitis in pregnancy

Objective To analyze the influencing factors of the prognosis of the women with fulminant hepatitis of pregnancy.Methods Single and multiple-factor logistic regression analysis was used to retrospectively analyze the data and the main factors for the prognosis of 60 pregnant women with fulminant hepatitis from July 1993 to December 2006 in the 3rd affiliated hospital of Sun Yet-sen University.Results Acute severe hepatitis as well as vaginal delivery,WBC＞20×109/L,TBIL＞350 μmol/L,CHOL≤2.9 mmol/L,Ca2+≤2.03 mmol/L,Na+≤136 mmol/L,FPG＜2.8 mmol/L,PTA≤20%,AFP≤300 μg/L,enzyme-bilirubin dissociation,HE,alimentary tract hemorrhage and HR is shown to be the influencing factor of the poor prognosis by the single factor analysis (P<0.05).TBIL,PTA,FPG and the clinical subtype are the main influencing factors by the multiple-factor analysis.Conclusions TBIL＞350 μmol/L,PTA≤20% or FPG＜2.8 mmol/L are the evidence for the poor prognosis of the fulminant hepatitis.The prognosis of the acute severe hepatitis is so poor and need be emphasized by the doctors.