肝性脑病患者预后不良危险因素分析

Analysis of prognostic risk factors of hepatic encephalopathy

目的回顾性分析肝性脑病(HE)患者的临床资料,探讨HE预后不良的危险因素。方法选取2014-01-01-2021-10-31中国人民解放军联勤保障部队第九二三医院感染科住院治疗的178例HE患者为研究对象,根据患者出院时的情况分为预后良好组和预后不良组。回顾性分析其临床资料,探讨影响HE预后不良的危险因素。结果178例HE患者中,预后良好组104例(58.4%),预后不良组74例(41.6%);男女比例为4.24∶1,男性预后不良发生率为45.1%,高于女性的14.1%,P<0.05;≤44、45~59、≥60岁的患者预后不良发生率分别为64.0%、43.3%、34.3%,青年患者预后更差,P<0.05。其中,肝硬化107例(60.1%)、原发性肝癌合并肝硬化45例(25.3%)、乙型肝炎20例(11.2%),其他6例(3.4%),病因与预后无关。178例患者中,明确诱因161例,合并多诱因患者预后更差,P<0.05。患者的HE分级越高、肝功能Child-Pugh分级越差、终末期肝病模型(MELD)评分越高,其预后不良发生率越高,均P<0.05。回归分析结果显示,HE分级(OR=3.769,95%CI为2.262~6.280)、发生酸碱失衡(OR=5.373,95%CI为1.772~16.289)、MELD评分(OR=1.178,95%CI为1.094~1.268)为HE患者预后不良的独立危险因素。结论HE患者合并诱因越多,其预后越差;HE分级、发生酸碱失衡及MELD评分是影响HE预后的独立危险因素。

Objective The data of patients with hepatic encephalopathy(HE)were retrospectively analyzed to investigate the clinical characteristics of HE and to explore the risk factors affecting the prognosis of HE.Methods Data of 178 cases of HE patients hospitalized in the 923 rd Hospital of the Joint Logistics Support Force of the People’s Liberation Army from January 1,2014 to October 31,2021 were collected.Patients with HE was divided into good prognosis group and poor prognosis group according to the condition of discharging.The clinical data were retrospectively analyzed to explore the risk factors affecting the poor prognosis of HE.Results Among a total of 178 patients with HE,there were 104 cases(58.4%)in good prognosis group and 74 cases in the poor prognosis group(41.6%).The ratio of male to female was 4.24∶1.The incidence of poor prognosis was higher in men than in women(45.1%vs 14.1%,P<0.05).Patients were divided into the young(≤44 years),middle-aged(45-59 years)and the elderly(≥60 years)age groups for investigating whether the prognosis was age-related.Result showed that incidence of poor prognosis was highest in the young age group(P<0.05),which was 64.0%,followed by middle-aged group and the elderly group,which were 43.3%and 34.3%,respectively.The causes of HE patients included liver cirrhosis,primary liver cancer with cirrhosis,hepatitis B,and others,which accounted for 60.1%,25.3%,11.2%and 3.4%,respectively.But etiology has nothing to do with prognosis.There were 161 cases who were confirmed the precipitating factor of HE.The more precipitating factors had,the worse prognosis was found(P<0.05).Furthermore,HE grades,Child-Pugh grade and model for end stage liver disease(MELD)score were significantly different between the good and poor prognosis group(P<0.05).The higher HE grades,the worse Child-Pugh grade and the higher MELD score means the poorer prognosis.Binary Logistic regression analysis showed that HE grades(OR=3.769,95%CI:2.262-6.280),acid-base imbalance(OR=5.373,95%CI:1.772-16.289)and MELD score(OR=1.178,95%CI:1.094-1.268)were independent risk factors for poor prognosis in HE patients.Conclusions Precipitating factor can be identified in most HE patients,and the more precipitating factors had,the worse the prognosis was found.The higher HE grades,Child-Pugh grade and MELD score,the worse the prognosis of HE was found.HE grade,acid-base imbalance and MELD score are independent risk factors affecting the prognosis of HE.