肝性脑病患者的临床特征及预后影响因素

【目的】探讨肝性脑病患者的临床特征和预后的影响因素。【方法】回顾306例肝性脑病患者的临床资料,对其诱因、复发、转归等进行分析。【结果】306例肝性脑病患者中C型占97.4%,消化道出血、感染、高蛋白饮食、电解质紊乱、氮质血症、便秘、镇静剂等诱因组及无诱因组分别占C型肝性脑病患者的23.5%、19.1%、15.4%、5.4%、4.0%、2.4%、0.3%、29.9%;以感染为诱因的肝性脑病患者死亡率最高(42.1%),该组的血氨值亦明显高于其他有诱因各组(P<0.05)。另外,死亡组ALT、TBILI、NR水平和Child-Pugh分级均较生存组升高(P<0.01),但胆碱酯酶、前白蛋白、血钠均较生存组下降(P<0.05);氨基酸分析显示,死亡组的芳香族氨基酸高于生存组(P<0.01),蛋氨酸、谷氨酸也明显高于生存组(P<0.05)。对反复发作的肝性脑病危险因素分析,血氨仍是独立危险因素之一。【结论】肝性脑病患者的预后与诱因和多项代谢指标相关,其中感染、血氨是肝性脑病的重要影响因素。治疗上应尽可能消除不良影响因素,降低肝性脑病的死亡率和复发率。

The study on the precipatating factors of prognosis of hepatic encephalopathy

【Objective】 To investigate the clinical features and prognostic factors of hepatic encephalopathy（HE）.【Methods】 The clinical data of 306 patients with HE were analyzed retrospectively.【Results】 There was 97.4% type C HE among 306 patients.The precipitating factors of type C HE included gastrointestinal bleeding（23.5%）,infection（19.1%）,high-protein diet（15.4%）,electrolyte imbalance（5.4%）,azotemia（4.0%）,constipation（2.4%）,sedative（0.3%）,respectively.And HE of no precipitating factors was 29.9%.The highest mortality rate（42.1%） was found in patients with HE induced by infection,their blood ammonia levels were also higher than other groups（P 0.05）.In addition,ALT,TBIL,INR and Child-Pugh scores were higher in the non-survival group in contrast to the survival group（P 0.01）,but the CHE,pre-albumin,serum sodium were decreased（P 0.05）.Amino acid analysis showed that aromatic amino acids were increased in the non-survival group than the survival group（P 0.01）,and methionine,glutamate were significantly higher in the non-survival group（P 0.05）.Furthermore,ammonia was an independent risk factor for recurrent HE.【Conclusion】 A number of precipitating factors and metabolic indicators are related with the prognosis of patients with HE.Infection,ammonia are the important factors.Treatment should pay attention to eliminate the negative factors,reducing mortality and recurrence rates.