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肝衰竭预后的危险因素分析
Causes of liver failure and impact analysis of prognostic risk factors
文章发布日期:2013年03月12日  来源:  作者:吴晓庆,万 红  点击次数:1812次  下载次数:448次

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【摘要】:目的探讨影响肝衰竭患者预后的危险因素。方法回顾性分析79例肝衰竭患者资料,收集年龄、性别、职业、血清总胆红素(TBil)、凝血酶原活动度(PTA)、总胆固醇(CHO)及并发症(感染、电解质紊乱、肝肾综合征、上消化道出血、肝性脑病)情况,分析这些指标与预后的关系。结果好转组与死亡组患者住院期间血清TBil最高值及CHO最高值、住院期间PTA上升的最高值及PTA降低的最低值,差异有统计学意义(P<0.01),而性别、年龄、职业、钾紊乱、入院时血清TBil、入院时CHO及CHO最低值差异无统计学意义(P>0.05)。相关并发症钠紊乱、感染、消化道出血、肝性脑病、肝肾综合征的发生在不同预后患者中存在统计学差异(P<0.05)。经Logistic多因素回归分析进一步筛选,发现5个与预后具有独立相关性的指标:住院期间TBil最高值、感染、肝肾综合征、上消化道出血、肝性脑病。结论住院期间TBil最高值、感染、肝肾综合征、上消化道出血、肝性脑病是影响肝衰竭预后的独立危险因素。
【Abstract】:ObjectiveTo perform a retrospective analysis of patients with liver failure to investigate the causative factors and related risk factors that may affect patient prognosis. MethodsThe clinical, demographic, and laboratory data of 79 consecutive patients diagnosed with liver failure and treated at our hospital between January 2010 and January 2012 (58 males and 21 females; age range: 16-74 years old) were collected from the medical records. To identify risk factors of liver failure, the patient variables were assessed by Student’s t-test (continuous variables) or Chi-squared test (categorical variables). Multivariate logistic regression analysis was used to investigate the relation between patient outcome and independent risk factors. ResultsThe 79 cases of liver failure were grouped according to disease severity: acute liver failure (n=6; 5 died), subacute liver failure (n=35; 19 died), and chronic liver failure (n=38; 28 died). The overall rate of death was 66%. The majority of cases (81%) were related to hepatitis B virus infection. While the three groups of liver failure severity did not show significant differences in sex, mean age, occupation, presence of potassium disorder, total bilirubin (TBil) or total cholesterol (CHO) at admission, or lowest recorded level of CHO during hospitalization, there were significant intergroup differences in highest recorded TBil level, prothrombin activity (PTA) at admission, and highest and lowest recorded PTA, and highest recorded level of CHO. Five independent risk factors were identified: the highest recorded TBil level during hospitalization, presence of infection, hepatorenal syndrome, gastrointestinal bleeding, and hepatic encephalopathy. ConclusionThe major cause of liver failure in this cohort of patients was hepatitis infection, and common biomarkers of liver function, such as TBil, CHO and PTA, may indicate patients with poor prognosis despite clinical intervention. Complications should be addressed as soon as possible to try to improve a patient’s potential for good outcome.
【关键字】:肝功能衰竭;预后;危险因素
【Key words】:liver failure; prognosis; risk factors
【引证本文】:

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