乙型肝炎病毒感染所致慢加急性肝衰竭的临床预后分析

目的 对影响乙型慢加急性肝衰竭预后的单因素进行分析,探讨影响慢加急性肝衰竭患者预后的危险因素.方法 将我院2006年1月-2008年6月收治的480例乙型慢加急性肝衰竭患者作为研究对象,分为好转治愈组和无效死亡组,将两组患者的临床资料进行组间比较,将有意义的单因素进一步行Logistic回归分析.结果 133例治愈好转组及347例无效死亡组患者,年龄、基础疾病、肝衰竭分期、持续低钠血症、甲胎蛋白、凝血酶原活动度、总胆红素、肌酐、白蛋白、肝性脑病、腹水、消化道出血等的差异有统计学意义(P值均<0.05);性别、家族史、是否首次发病、有无休克血压等的差异无统计学意义(P值均>0.05).Logistic回归分析结果表明,凝血酶原活动度、低钠血症,肝性脑病、基础疾病和消化道出血是乙型慢加急性肝衰竭的独立危险因素(x2值分别为10.570,15.181,37.041,11.886,4.853,P值均<0.05).结论 凝血酶原活动度、低钠血症、肝性脑病、基础疾病和消化道出血5个因素对慢加急性肝衰竭的预后有重要意义.

Analysis of prognostic factors for patients with acute-on-chronic liver failure

Objective To analyze the prognostic factors for patients with acute-on-chronic fiver failure,and to bulid a scoring system for assessment of the prognosis of fiver failure.Methods 480 patients with acute-on-chronic liver failure in our hospital from January 2006 to June 2008 were enrolled in this study.The patients were divided into improved group and deteriorated group.The clinical data were analyzed by using chi square test,independent-Samples T Test and Binary logistic regression.Result The factors that significantly affected the prognosis of Acute-on-chronic Liver Failure included age,hepatitis or fiver cirrhosis,Staging,Hyponatremias,alpha-fetoprotein (AFP),the prothrombin time activity (PTA),total bilimbin (TBil),ereatinine (Cr),albumin (ALB) and Hepatic encephalopathy,ascites,alimentary tract hemorrhage (P<0.05,P<0.01).PTA,Hyponatremias,hepatitis or liver cirrhosis,Hepatic encephalopathy and alimentary tract hemorrhage were independent risk factors of prognosis.Conclusion PTA,Hyponatremias,hepatitis or liver cirrhosisf-Hepatic encephalopathy and alimentary tract hemorrhage are inportant to build a scoring system to assess the prognosis of Acute-on-chronic Liver Failure and may be useful to guide clinical treatment.