乙型肝炎患者感染性发热与肝衰竭的相关性分析

摘要

Objective To observe influential febrile factors in the precursors of the patients with acute hepatitis B , and also to analyze the effects of infectious febrile on the disease course of acute hepatic failure .Methods An investigation was made on the 210 patients with acute hepatitis B treated in the hospital from January 2013 to January 2017 and the patients were divided into the fever group and the control group by depending on whether or not they had fever at the initial stage , each consisting of 105 patients.Serum biochemical indexes were compared between the two groups , then, the association of related factors between fever and acute liver failure was analyzed by using multiple factor Logist regression method .Results In the fever group, alanine aminotransferase (ALT), total bil-irubin (TBIL) and INR were higher than those of the control group , and albumin, HBeAg positive rate and HBsAg >250 IU/ml were lower than those of the control group (P<0.05).There was no statistical significance between HBV and DNA (P>0.05).The inci-dence of acute liver failure in the fever group was higher than that in the control group (P<0.05), but there was no significant differ-ence in liver failure mortality (P>0.05).Logist multivariate analysis showed that albumin level was lower than 40 g/L, INR was high-er than 1.1 and platelet was lower than150 ×109/L.Negative HBeAg at admission of hospital was an independent risk factor of acute hepatitis B fever at the initial stage .Multi-factor Logist regression analysis revealed that fever at the initial stage was an independent risk factor for acute liver failure .Conclusion There was a clear correlation between fever at the initial stage and liver failure in the patients with acute hepatitis B .For this reason , clinicians should be highly aware , so as to avoid occurrence of such adverse events .%目的 观察急性乙型肝炎患者前驱期发热影响因素,并分析感染性发热对急性肝衰竭病程的影响.方法 调查2013年1月至2017年1月当阳市人民医院治疗的急性乙型肝炎患者210例,按照前驱期是否发热分为发热组和对照组(每组105例).比较2组血清生化学指标,利用多因素Logist回归分析发热组患者发热及急性肝衰竭的相关因素.结果 发热组谷丙转氨酶(ALT)、总胆红素(TBIL)、国际标准化比值(INR)高于对照组,白蛋白、乙肝E抗原(HBeAg)阳性率、乙肝表面抗原(HBsAg)>250 IU/ml低于对照组(P<0.05),乙肝病毒(HBV)DNA与对照组差异无统计学意义(P>0.05);发热组急性肝衰竭发生率高于对照组(P<0.05),肝衰竭死亡率与对照组差异无统计学意义(P>0.05);多因素Logist分析,白蛋白<40 g/L、INR>1.1、血小板<150×109/L,入院时HBeAg阴性是急性乙型肝炎前驱期发热的独立危险因素;调整急性肝衰竭相关指标,多因素Logist回归分析,前驱期发热是发生急性肝衰竭的独立危险因素.结论 前驱期出现发热症状与急性乙型肝炎患者发生肝衰竭存在明确的相关性,临床对此类患者需提高警惕,避免不良事件发生.