106例慢加急性肝衰竭合并肝性脑病患者预后影响因素的Logistic回归分析

崔燕平; 刘凤华; 石庆凤; 赵洪奎; 王思奎

doi:10.3969/j.issn.1001-5256.2014.10.005

106例慢加急性肝衰竭合并肝性脑病患者预后影响因素的Logistic回归分析

DOI: 10.3969/j.issn.1001-5256.2014.10.005

聊城市人民医院

详细信息

中图分类号: R575.3;R747.9
计量
- 文章访问数: 2873
- HTML全文浏览量: 7
- PDF下载量: 680
- 被引次数: 0
出版历程
- 收稿日期: 2014-01-17
- 出版日期: 2014-10-20

Logistic regression analysis of prognostic factors in 106 acute-on-chronic liver failure patients with hepatic encephalopathy

Liaocheng People's Hospital

摘要

摘要:
目的对影响慢加急性肝衰竭（ACLF）伴肝性脑病（HE）患者预后的因素进行分析,探讨影响预后的危险因素。方法回顾性分析2010年1月-2013年7月在聊城市人民医院住院的106例ACLF伴HE患者的临床资料,分为好转组（n=15）和恶化组（n=91）,将两组患者的单因素指标:年龄、性别、实验室指标[TBil、Alb、ALT、AST、凝血酶原活动度（PTA）]、HE分期及并发症[持续性低钠血症、消化道出血、肝肾综合征（HRS）、腹水、感染、自发性细菌性腹膜炎（SBP）]、血浆置换进行χ2检验或t检验,再将有意义的单因素进一步行Logistic回归分析。结果单因素分析显示,ALT、PTA、HE分期、HRS差异有统计学意义（P值分别为0.009、0.043、0.000、0.003）;性别、年龄、持续低钠血症、消化道出血、感染、SBP、腹水、TBil、Alb、AST、血浆置换差异无统计学意义（P>0.05）。经二元Logistic回归分析得出,PTA、HRS、HE分期对ACLF伴HE患者的预后有意义,回归系数分别为-0.097、2.279、1.873,P值分别为0.025、0.007、0....
- 肝功能衰竭 /
- 肝性脑病 /
- Logistic模型
Abstract:
Objective To analyze the prognostic factors in acute-on-chronic liver failure ( ACLF) patients with hepatic encephalopathy ( HE) and to explore the risk factors for prognosis. Methods A retrospective analysis was performed on106 ACLF patients with HE who were hospitalized in our hospital from January 2010 to July 2013. The patients were divided into improved group and deteriorated group. The univariate indicators including age, sex, laboratory indicators [total bilirubin ( TBil) , albumin ( Alb) , alanine aminotransferase ( ALT) , aspartate amino-transferase ( AST) , and prothrombin time activity ( PTA) ], the stage of HE, complications [persistent hyponatremia, digestive tract bleeding, hepatorenal syndrome ( HRS) , ascites, infection, and spontaneous bacterial peritonitis ( SBP) ], and plasma exchange were analyzed by chi-square test or t-test. Indicators with statistical significance were subsequently analyzed by binary logistic regression. Results Univariate analysis showed that ALT ( P = 0. 009) , PTA ( P = 0. 043) , the stage of HE ( P = 0. 000) , and HRS ( P = 0. 003) were significantly different between the two groups, whereas differences in age, sex, TBil, Alb, AST, persistent hyponatremia, digestive tract bleeding, ascites, infection, SBP, and plasma exchange were not statistically significant ( P >0. 05) . Binary logistic regression demonstrated that PTA ( b =-0. 097, P =0. 025, OR =0. 908) , HRS ( b =2. 279, P =0. 007, OR =9. 764) , and the stage of HE ( b = 1. 873, P = 0. 000, OR = 6. 510) were prognostic factors in ACLF patients with HE. Conclusion The stage of HE, HRS, and PTA are independent influential factors for the prognosis in ACLF patients with HE. Reduced PTA, advanced HE stage, and the presence of HRS indicate worse prognosis.
- liver failure /
- hepatic encephalopathy /
- logistic models

HTML全文

参考文献(15)

[1] Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, MA;Severe Liver Diseases and Artificial Liver Group Chinese Society of Hepatology, MA.Guideline for diagnosis and treatment of liver failure (2012 version) [J].Chin J Clin Infect Dis, 2012, 12 (5) :321-326. (in Chinese) 中华医学会感染病学分会肝衰竭与人工肝治疗组、中华医学会肝病学分会重肝与人工肝学组.肝衰竭诊治指南 (2012年版) [J].中华临床感染病杂志, 2012, 12 (5) :321-326.

[2]Hepatic Encephalopathy Diagnosis and Treatment of the Expert Committee.Expert consensus on diagnosis and treatment of hepatic encephalopathy[J/CD].Chin J Exp Clin Infect Dis:Electronic Edition, 2009, 3 (4) :449-473. (in Chinese) 肝性脑病诊断治疗专家委员会.肝性脑病诊断治疗专家共识[J/CD].中华实验和临床感染病杂志:电子版, 2009, 3 (4) :449-473.

[3]FICHET J, MERCIER E, GENE O, et al.Prognosis and 1-year mortality of intensive care unit patients with severe hepatic encephalopathy[J].J Crit Care, 2009, 24 (3) :364-370.

[4]XIE SB, WU YK, ZHU JY, et al.Establishment and evaluation of prognosis scoring system for acute-on-chronic liver failure[J].J Sun Yat-sen univ:Medical Sciences, 2011, 32 (6) :834-840. (in Chinese) 谢仕斌, 吴元凯, 朱建芸, 等.慢加急性肝衰竭预后评分系统的建立与评估[J].中山大学学报:医学科学版, 2011, 32 (6) :834-840.

[5]LIU XY, CHEN J, WANG XX, et al.Etiological analysis of 3233patients with acute liver failure, subacute liver failure and acuteon-chronic liver failure[J].Clin Med Engineering, 2012, 19 (5) :823-825. (in Chinese) 刘晓燕, 陈婧, 王晓霞, 等.3233例急性、亚急性、慢加急性肝衰竭病因特点分析[J].临床医学工程, 2012, 19 (5) :823-825.

[6] LIU XY, HU JH, WANG HF, et al.Etiological analysis of 1977 patients with acute liver failure, subacute liver failure and acute-onchronic liver failure[J].Chin J Hepatol, 2008, 16 (10) :772-775. (in Chinese) 刘晓燕, 胡瑾华, 王慧芬, 等.1977例急性、亚急性、慢加急性肝衰竭患者的病因与转归分析[J].中华肝脏病杂志, 2008, 16 (10) :772-775.

[7]ZENG Z, LOU M, CHANG XJ, et al.Clinical characteristics and prognosis of four types of liver failure[J].Infect Dis Info, 2008, 21 (6) :353-354. (in Chinese) 曾珍, 楼敏, 常秀娟, 等.四类肝衰竭的临床特点与转归分析[J].传染病信息, 2008, 21 (6) :353-354.

[8]YU YH, JIANG JN, WU JZ, et al.Logistic regression analysis of prognostic factors for hepatic encephalopathy[J].Chin J Infect Dis, 2009, 27 (5) :305-307. (in Chinese) 玉艳红, 江建宁, 吴继周, 等.肝性脑病患者预后影响因素的Logistic回归分析[J].中华传染病杂志, 2009, 27 (5) :305-307.

[9]TAO C, YUAN CB, ZENG WQ, et al.Analysis of causes of death in 72 patients with chronic severe hepatitis[J].Chin J Primary Med Pharm, 2008, 15 (9) :1497-1498. (in Chinese) 陶晨, 袁春蓓, 曾文权, 等.慢性重型肝炎72例死亡原因分析[J].中国基层医药, 2008, 15 (9) :1497-1498.

[10]YE PY, YANG ZG, CHEN XR, et al.Risk factors associated with prognosis of progressive stages of acute-on-chronic hepatitis B liver failure[J].J Clin Hepatol, 2013, 29 (4) :270-275. (in Chinese) 叶佩燕, 杨宗国, 陈晓蓉, 等.HBV相关慢加急性肝衰竭不同分期的预后评价及影响因素分析[J].临床肝胆病杂志, 2013, 29 (4) :270-275.

[11]YANG B, WU YK, CHEN ZC, et al.The dynamic changes of ALT, AST, TBil and PT and their relationship with prognosis of acute-on-chronic hepatitis B liver failure[J].J Clin Hepatol, 2012, 28 (3) :205-208. (in Chinese) 杨波, 吴元凯, 陈忠诚, 等.ALT、AST、TBil及PT变化趋势与慢加急性乙型肝炎肝衰竭预后的关系[J].临床肝胆病杂志, 2012, 28 (3) :205-208.

[12] LIU XY, HU JH, WANG HF, et al.Analysis of prognostic factors for patients with acute-on-chronic liver failure[J].Chin J Hepatol, 2009, 17 (8) :607-610. (in Chinese) 刘晓燕, 胡瑾华, 王慧芬, 等.乙型肝炎病毒感染所致慢加急肝衰竭的临床预后分析[J].中华肝脏病杂志, 2009, 17 (8) :607-610.

[13]LAI N, GUO SH, ZHANG DZ, et al.A single factor analysis of the prognosis of 301 hepatitis failure cases and a study of a scoring system on their prognostic assessment[J].Chin J Hepatol, 2005, 13 (8) :586-589. (in Chinese) 赖宁, 郭树华, 张大志, 等.重型肝炎预后单因素分析与预后评估系统研究[J].中华肝脏病杂志, 2005, 13 (8) :586-589.

[14]SUN LH, ZHANG YX, XIAO L, et al.Analysis of the prognosis of severe hepatitis treated with molecular adsorbent recycling system (MARS) using MELD score[J].Chin J Hepatol, 2005, 13 (8) :632-635. (in Chinese) 孙丽华, 张跃新, 肖琳, 等.终末期肝病评分模型评价分子吸附再循环系统治疗重型肝炎的疗效和预后[J].中华肝脏病杂志, 2005, 13 (8) :632-635.

[15]LIAO JM, LI ZR, HU XX.The therapeutic effect of plasma exchange therapy in patients with severe hepatitis[J].J Clin Hepatol, 2012, 28 (4) :302-304. (in Chinese) 廖金卯, 李灼日, 胡小宣.人工肝血浆置换治疗重型肝炎的疗效观察[J].临床肝胆病杂志, 2012, 28 (4) :302-304.

施引文献

资源附件(0)

访问统计