肝性脑病患者短期预后的相关危险因素分析

摘要

目的 探讨肝性脑病(HE)患者短期预后相关的危险因素.方法 回顾性分析2013年1月-2015年12月于吉林大学第一医院住院治疗的316例HE患者的临床资料,根据预后分为生存组(n =229)与死亡组(n=87).将患者基础资料及生化指标进行单因素及多因素分析,筛选影响HE预后的危险因素.计量资料2组间比较采用t检验或Mann-Whitney U检验,计数资料2组间比较采用x2检验.将单因素分析中有统计学意义的变量进一步行多因素logistic回归分析.结果 316例患者的男女比例为1.72∶1,45岁及以上患者269例(85.13％).单因素分析结果显示年龄、合并原发性肝癌、HE分期、WBC、中性粒细胞、Hb、PLT、国际标准化比值、PT、PTA、尿素氮、肌酐、血清钠、血清钾、ALT、AST、GGT、Alb、IBil、TBil、前白蛋白在2组之间差异均有统计学意义(P值均＜0.05).多因素logistic回归分析结果显示合并原发性肝癌[比值比(OR) =3.278,95％可信区间(95％CI):1.494 ～7.194,P =0.003]、HE分期(OR =2.402,95％CI:1.711 ～3.372,P ＜0.001)、PTA(OR =0.969,95％ CI:0.951～0.988,P =0.001)、血清钠(OR=0.956,95％ CI:0.922 ～ 0.992,P=0.018)、TBil(OR=1.004,95％CI:1.003～1.006,P＜0.001)是影响HE患者预后的独立危险因素.结论 合并原发性肝癌、HE高分期、低血钠、PTA降低、TBil升高是影响HE预后的独立危险因素,据此建立的方程对临床有一定参考价值.%Objective To investigate the risk factors for poor short-term prognosis of patients with hepatic encephalopathy (HE).Methods A retrospective analysis was performed for the clinical data of 316 patients with HE who were hospitalized and treated in The First Hospital of Jilin University from January 2013 to December 2015,and according to their prognosis,they were divided into survival group (229 patients) and death group (87 patients).The univariate and multivariate analyses were performed for their general data and biochemical parameters to screen out the risk factors for poor prognosis of HE.The t-test or Mann-Whitney U test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.The multivariate logistic regression analysis was performed for the variables with statistical significance identified in the univariate analysis.Results All the patients were followed up for 30 days,and 87 patients died,resulting in a mortality rate of 27.5％.The male/female ratio was 1.72∶ 1,and 269 patients (85.13％) were aged ≥45 years.The univariate analysis showed that there were significant differences between the two groups in age,a combination of primary liver cancer,HE stage,white blood cell count,neutrophil count,hemoglobin,platelet count,international normalized ratio,prothrombin time,prothrombin time activity (PTA),blood urea nitrogen,creatinine,serum sodium,serum potassium,alanine aminotransferase,aspartate aminotransferase,gamma-glutamyl transpeptidase,albumin,indirect bilirubin,total bilirubin (TBil),and prealbumin (all P ＜0.05).The multivariate analysis showed that a combination of primary liver cancer (OR =3.278,95％ CI:I.494-7.194,P=0.003),HE stage (OR =2.402,95％CI:1.711-3.372,P ＜0.001),PTA (OR =0.969,95％CI:0.951-0.988,P=0.001),serum sodium (OR =0.956,95％ CI:0.922-0.992,P =0.018),and TBil (OR =1.004,95％ CI:1.003-1.006,P ＜ 0.001)were independent risk factors for the prognosis of patients with HE.Conclusion A combination of primary liver cancer,advanced HE stage,low serum sodium,low PTA,and increased TBil are independent risk factors for poor prognosis of HE,and the equation based on these indices has a certain reference value in clinical practice.