肝硬化腹水患者预后的危险因素研究

为探讨影响肝硬化腹水患者预后的危险因素 ,建立判断其预后的评分系统 ,随机选择肝硬化腹水患者 1 80例 (存活组 89例 ,死亡组 91例 ) ,统计其年龄、肝硬化相关的并发症、肝脏生化、腹水检查结果等 2 2个指标 ,进行单因素分析 ,并将P <0 .0 5的指标进行Logistic回归分析。结果 :单因素分析发现 ,年龄、消化道出血、肝性脑病、肝肾综合征、休克、腹水白细胞数、外周白细胞数、凝血酶原活性、白蛋白、血清总胆红素、血清尿素氮及低钠血症与肝硬化腹水患者预后有关 (P <0 .0 5～ 0 .0 0 0 )。Logistic回归发现 ,凝血酶原活性、肝性脑病、血清尿素氮及低钠血症是影响肝硬化腹水患者预后的独立危险因素。以凝血酶原活性等 4个指标建立一个判断肝硬化腹水患者预后的评分系统 ,以总分≥ 5为判断死亡的临界值 ,预测死亡的正确率为 91 .2 % ,预测生存的正确率为 94.3 % ,符合率为 91 .7%。

Predictive Survive of Cirrhotic Patients with Ascites: Study on Multiple Risk Factors

The aim is to study on the risk factors of predictive survive of cirrhotic patients with ascites, and to design a scoring system which could determine patient's prognosis. One hundred eighty randomized patients at the end of hospitalization were divided into alive group(n=89)and death group(n=91). Twenty two clinical and laboratory parameters were investigated as predictive risk factors for patients survival. Univariate analysis was made with the χ² test for qualitative variable and independent sample t-test for quantitative variable. Variables reaching statistical significance(P<0.05)were subsequently introduced in Logistic regression to identify the independent risk factors for survive. The methods of statistical analysis were performed with SPSS for WINDOWS statistical package. Results: tweleve clinical and laboratory paramenters, age, GI bleeding, hepatic encephalopathy, sydrome of hepatic kinedy, shock, count of ascites WBC and blood WBC, PTA, total bilirubin, serum ALB, sodium concentration and BUN, were closely related to survival of cirrhotic patients with ascites by analysis of univariate. Four independent factors, hepatic encephalopathy(HE), PTA, serum sodium concentration(NA)and BUN, the determined patient′s survive by Logistic regression analysis. A scoring system was designed accroding to the 4 paramenters. The artical score of death was 5. The coincidence rate was 91.7% by retrospective study of 180 cirrhotic patients.