首页> 中文期刊> 《临床肝胆病杂志》 >乙型肝炎相关慢加急性肝衰竭患者的预后因素分析

乙型肝炎相关慢加急性肝衰竭患者的预后因素分析

         

摘要

目的 探讨影响乙型肝炎相关慢加急性肝衰竭患者预后的危险因素.方法 记录263例乙型肝炎相关慢加急性肝衰竭患者治疗基线时血清胆碱酯酶、白蛋白及胆固醇等反应肝脏储备功能的临床指标及重要并发症的发生情况,并计算其MELD评分.所有患者随访满1年.通过Cox比例风险回归模型筛选出影响预后的独立危险因素.结果 在1年的随访时间内,67例死亡,病死率为25.5%.死亡组血清胆碱酯酶、白蛋白、胆固醇水平均较存活组低.血清胆固醇水平随着MELD值的升高而下降.Cox比例风险回归模型分析得出,肝性脑病、肝肾综合征、上消化道出血、胆固醇≤2.5 mmol/L、MELD评分≥30是影响乙型肝炎相关慢加急性肝衰竭患者预后的独立危险因素,RR分别为6.286、2.983、2.272、2.168及1.853.结论 胆固醇≤2.5 mmol/L、肝性脑病、肝肾综合征、上消化道出血及MELD评分≥30是决定乙型肝炎相关慢加急性肝衰竭患者预后的主要危险因素.%Objective To investigate the prognostic value of risk factors in hepatitis B patients with acute - on - chronic liver failure (ACLF). Methods A total of 263 patients with hepatitis B - ACLF were enrolled in the study. The baseline levels of albumin ( Alb) , cholinesterase ( CHE) , and total cholesterol (TC) were measured, any complications were recorded, and the MELD score was calculated. All of the patients were followed - up for one year. The prognostic value of known risk factors was analyzed by the multivariate Cox proportional hazard model. Results Sixty - seven patients died within the 1 - year follow - up period, yielding a mortality rate of 25. 5%. The baseline levels of Alb, CHE, and TC were all significantly lower in the patients who ultimately died than in those who survived. The serum TC level was found to be inversely correlated with increases in the MELD score. Hepatic encephalopathy, hepatorenal syndrome, gastrointestinal bleeding, TC≤2. 5 mmol/L, and MELD score≥30 were identified as independent prognostic factors for hepatitis B - ACLF. Conclusion Several risk factors of hepatitis B -ACLF are prognostic factors of disease outcome, namely death within one year, including hepatic encephalopathy, hepatorenal syndrome, gastrointestinal bleeding, TC≤2.5 mmol/L, and MELD ≥30.

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