影响1型肝肾综合征患者预后因素的临床研究

目的:寻找影响1型肝肾综合征(HRS)患者预后的危险因素,为降低HRS发病率,提高临床疗效,判断预后提供参考.方法:回顾性分析105例HRS患者的病历资料,采用1996年国际腹水联合会诊断标准分为1型HRS和2型HRS,记录所有入选患者人口统计学指标、生化指标、治疗情况和预后,计算终末期肝病(MELD)评分和简化MEL...

The Clinical Research of Prognostic Factors for Patients with Type 1 Hepatorenal Syndrome

Objective：We aimed to know the significant predictors of type 1 hepatorenal syndrome （HRS）.In addition to the initial model of end-stage liver disease （MELD） scores and biochemistry parameters,we want to further investigate the prognostic importance of changes in MELD scores and biochemistry parameters over time for patients with type 1 HRS.Methods：This is a retrospective study,data from type 1 HRS patients were incorporated,including their demographic,clinical progression,all recording biochemical parameters,therapeutic methods,and outcomes.MELD score simple were calculated by CRE and TBI.Kaplan-Meier estimates of survival curves were calculated for patients with type 1 and type 2 HRS.The probable danger factors,such as creatinine （CRE）,total bilirubin（TBI）,were included into the time-dependent proportional hazards model to get the prognostic factors.Results：A total of 105 patients were included in the study.According to the definition of the International Ascites Club,68 patients（or 64.76%） had type 1 HRS whereas 37（or 35.24%） had type 2 HRS.According to the multivariate COX proportional hazards regression model,either initial biochemistry parameters or MELD scores were not significantly associated with prognosis.By time-dependent proportional hazards model,each point elevated in CRE and total TBI levels during the admission increased mortality risk by 29.3% and 4.2%,respectively.Increasing albumin level during the admission showed its protective value.Changes in MELD score simple during the admission were significant predictor for patients with type 1 HRS.Conclusion：In patients with type 1 HRS,changes in TBI,CRE,and albumin level during the admission were associated with prognosis.Changes in MELD score simple is superior to initial and changes in MELD scores to predict prognosis in patients with type 1 HRS.