慢性肝病患者发生肝性脑病的危险因素

Risk factors for hepatic encephalopathy in patients with chronic liver diseases

目的探讨慢性肝病患者发生肝性脑病(hepatic encephalopathy,HE)的危险因素。方法以2014—2019年医院收治的64例HE患者为研究对象。以HE患者首次明确诊断为肝炎或肝硬化的时间为研究起点,首次发作HE作为研究终点,通过单因素和多因素分析,探讨引发HE可能的独立危险因素。结果单因素和多因素分析表明,年龄(OR:1.066,P<0.0001)、肝硬化(7.979,P<0.0001)、乙肝病毒(HBV)感染及治疗(5.838,P<0.0001)、脾脏肿大(2.722,P=0.003)、食管胃底静脉曲张(EGV,1.986,P=0.024)和ALT水平高低(2.940,P<0.0001)是影响HE发病的独立危险因素。肝病患者HE 1年、3年、5年、10年的发病率分别是14.06%、34.38%、42.19%和85.94%。结论年龄、肝硬化、HBV感染及治疗、脾大、EGV和血清ALT水平是潜在预判肝病患者HE发作的临床指标。

Objective To explore the independent risk factors for hepatic encephalopathy(HE)in patients with liver diseases.Methods Sixty-four patients with HE who visited our hospital between 2014 and 2019 were enrolled in this study.These patients were divided into two groups:the male group(n=51)and female group(n=13).The clinical characteristics were compared between the two groups so as to find the difference between the two genders.The first definitive diagnosis of hepatitis or cirrhosis was taken as the starting point and the first attack of HE as the end point.Possible independent risk factors for HE were explored based on univariate and multivariate analysis.Results Univariate and multivariate analysis showed that age(OR:1.066,P<0.0001),cirrhosis(7.979,P<0.0001),hepatitis B virus infection and treatment(5.838,P<0.0001),splenomegaly(2.722,P=0.003),esophagogastric varices(EGV,1.986,P=0.024)and ALT level(2.940,P<0.0001)were independent risk factors for HE.The 1-,3-,5-and 10-year incidence of HE was 14.06%,34.38%,42.19%and 85.94%,respectively.Conclusions Male HE patients have more of a pathological basis of cirrhosis and higher serum total bilirubin levels than female ones during the early stage.Age,cirrhosis,hepatitis B virus infection and anti-virus treatment,splenomegaly,EVG and serum ALT levels are potential clinical indicators for predicting HE attack in patients with liver diseases.