重型肝炎预后单因素分析与评估系统研究

A single factor analysis of the prognosis of 301 hepatitis failure cases and a study of a scoring system on their prognostic assessment

目的对影响重型肝炎预后的单因素进行分析,从中筛选出对预后有明显影响的因素,并确定其与预后的相关程度,从而构建出重型肝炎预后评估系统,并检验其效能。方法将重庆医科大学附属第二医院感染病科1997年1月至2003年3月收治的301例重型肝炎患者分为治疗有效组和治疗无效组,分别从年龄,性别、临床分型、病原分型、并发症,既往病史、生化指标等方面进行回顾性研究,借助SPSS 软件进行Logistic回归分析,确定这些因素与重型肝炎预后的相关程度。利用得到的独立危险因素和各自的相关系数构建重型肝炎预后评分公式,将原始数据代人公式进行评分,验证系统的评估效能。结果年龄、临床分型、肝性脑病、电解质紊乱、原发性腹膜炎、酸碱失衡、肝肾综合征、消化道出血、既往肝硬化基础、酶胆分离、凝血酶原活动度、总胆红素、尿素氮、肌酐、血钠等指标与预后有明显的关系。进一步的Logistic回归分析提示:凝血酶原活动度、尿素氮、血钠、肝性脑病为影响预后的独立的危险因素。对构建的评估系统的评价效能进行研究发现:治疗有效组和治疗无效组评分差异有统计学意义(P<0.01);低于40 分组,治疗有效率为76.9%,40～80分组,治疗有效率仅12.5%;80分以上组,治疗均无效,两组评分差异亦有统计学意义。结论凝血酶原活动度、尿素氮、血钠、肝性脑病作为独立的危险因素可用于预后评分系统的构建。本研究构建的重型肝炎预后评估系统能较好地反映预后。

Objectives To analyze the factors related to prognosis of hepatitis failure and to determine the factors which significantly affect it, and to build a scoring system for assessment of the prognosis of hepatitis failure and also to examine its efficacy for clinical use. Methods Clinical data from 301 patients were analyzed retrospectively. The correlated degree between those single factors and prognosis of hepatitis failure was explored by logistic regression analysis. Independent risk factors of prognosis and those correlated coefficients, which were from logistic regression analysis, were used to build a scoring system. This system was used in analyzing the clinical data of 275 patients to examine its efficacy of the prognostic assessment. Results The factors that significantly affected the prognosis of hepatitis failure included age, clinical typing, hepatic coma, total bilirubin, and others （P〈0.01）. Some factors, including PTA,blood urea, sodium and hepatic coma, were independent risk factors of prognosis. The scoring system built gave different scores between the effective treatment group and ineffective treatment group with statistical significance （P〈0.01）.When the score was less than 40, the probability of a recovery was 76.9%; when the score was 40 to 80, the probability of a recovery was only 12.5%. When the score was more than 80, the probability of a recovery dropped to 0%.Conclusions The factors, including PTA, blood urea and sodium and hepatic coma, are important in building a scoring system t6 assess the prognosis of hepatitis failure. The scoring system we built is very effective in evaluating the prognosis of hepatitis failure.