戊型肝炎肝衰竭死亡原因分析*

目的 分析影响戊型肝炎肝衰竭患者预后的影响因素,为其防治提供经验。方法 2009年3月~2016年3月收治的慢加急性戊型肝炎肝衰竭患者140例,经内科综合治疗后生存63例,死亡77例。回顾性分析生存与死亡患者肝功能指标,采用Logistic多元回归分析进行单因素和多因素分析影响预后的危险因素。结果 死亡组血清甲胎蛋白峰值水平仅为（47.6±8.9） ng/ml,显著低于生存组[（175.8±254.1） ng/ml,P<0.05],血清总胆红素峰值水平为（377.3±164.6） μmol/L,显著高于生存组[（251.7±151.4） μmol/L,P<0.05],凝血酶原时间国际标准化比值（INR）为（2.4±0.6）,显著高于生存组【（1.6±0.2）,P<0.001】,血清白蛋白水平为（32.2±9.9） g/L,显著低于生存组【（35.8±8.2） g/L,P<0.05】;单因素分析结果显示,年龄大于60岁（P<0.001）、有肝脏基础疾病（P=0.032）、并发肝性脑病（P=0.024）、存在感染（P=0.03）、并发消化道出血（P=0.014）、有腹水（P=0.02）为影响慢加急性戊型肝炎肝衰竭患者预后的危险因素;多因素回归分析结果显示,肝性脑病（P=0.005）、感染（P<0.001）、消化道出血（P=0.001）和基础肝病 （P=0.004）是影响慢加急性戊型肝炎肝衰竭患者预后的独立危险因素。结论 部分戊型肝炎患者会发展至肝衰竭,以慢加急性肝衰竭为多见,内科综合治疗仅在不到一半的患者有效,而血清胆红素水平和INR太高患者预后不良,并发肝性脑病、感染、消化道出血和有基础肝病是影响慢加急性戊型肝炎肝衰竭患者预后的独立危险因素,可作为判断肝衰竭患者预后的临床指标,对此类患者应进行积极的护理和治疗,预防并发症的发生,以提高患者生存率。

Risk factors for poor prognosis of patients with hepatitis E-induced liver failure

Objective To analyze the risk factors for poor prognosis of patients with hepatitis E-induced liver failure. Methods 140 patients with hepatitis E-induced liver failure were admitted to our hospital between March 2009 and March 2016. 63 patients survived and 77 died. The independent risk factors for poor prognosis were analyzed by univariate and multivariate Logistic analysis. Results The peak serum alpha-fetoprotein level in dead patients was（47.6±8.9） ng/ml,significantly lower than（175.8±254.1） ng/ml（P<0.05） in the survival,total serum bilirubin level was（377.3±164.6） μmol/L,much higher than （251.7±151.4） μmol/L （P<0.05） in the survival,the INR was（2.4±0.6）,much higher than[（1.6±0.2）,P<0.001] in the survival,while serum albumin level was （32.2±9.9） g/L,significantly lower than（35.8±8.2）g/L （P<0.05） in the survival;univariate analysis showed that older than 60 year （P<0.001）,with underlying liver disease （P=0.032）,complicated by hepatic encephalopathy （HE,P=0.024）,infection （P=0.03）,gastrointestinal bleeding （GIB,P=0.014） and with ascites （P=0.02） were the related factors impacting prognosis,and multivariate Logistic analysis demonstrated that HE （P=0.005）,infection （P<0.001）,GIB（P=0.001） and underlying liver disease（P=0.004） were the independent risk factors for poor prognosis of patients with hepatitis E-induced chronic-on-acute liver failure. Conclusion Some patients with hepatitis E would deteriorate to liver failure,and the chronic-on-acute are common. About fifty percent of the patients survive with conventional supporting treatment,and patients with hyperbilirubinemia and extremely elevated INR would have poor prognosis,especially in patients with underlying liver diseases and complicated by HE, infection and GIB. Clinicians should take this into consideration to deal with the patients with hepatitis E at risk carefully for improvement of prognosis.