检验指标对慢性乙型重型肝炎预后影响的单因素与多因素分析

Univariate and Multivariate Analysis of Test Indexes Affecting the Prognosis of Patients with Choronic Severe Hepatitis B

目的探讨检验指标对慢性乙型重型肝炎预后影响的单因素和多因素因子，指导检验和临床。方法回顾性分析2002年7月-2004年12月北京地坛医院住院慢性乙型重型肝炎206例患者，以各种可能影响本病预后的检验指标及其他因素做单因素分析和多因素分析。结果在检验指标中影响慢性乙型重型肝炎预后的单因素有：PTA〈20％、AST／ALT〉1．2、TBil〉513μmol/L、ALB〈30g／L、CHO〈1．6mmol／L、CHE〈4000U／L、PLT〈50×10^9／L、较高HBV DNA水平（HBeAg阴性者HBV DNA≥3×10^4拷贝／毫升，HBeAg阳性者HBV DNA≥1×10^5），此8项指标与患者的不良预后相关。经Logistic多元回归分析显示有5项检验指标为慢性乙型重型肝炎预后不良的独立预测因子，分别是PTA〈20％、ALB〈30g／L、CHO〈1．6mmol／L、PLT〈50×10^9／L、较高水平HBV DNA，其回归系数分别是1．731、2．153、1．872、2．375和2．134。结论有8项单因素和5项多因素检验指标提示慢性乙型重型肝炎预后不良，特别是较高载量HBV DNA和PLT计数对其预后的影响值得检验和临床工作者的高度重视。

Objective Objective To investigate single factors and multiple factor of prognosis of the chronic severe hepatitis B and to guide examination and clinical practice. Methods 206 patiants with chronic severe hepatitis B hospitalized in Beijing Ditan Hospital from Jul. 2002 to Dec. 2004 were analyzed retrospectively. A single and multiple factor analysis by means of the test indexes and other factors which may inflnence prognosis of the chronic severe hepatitis B was conducted. Results Among test indexes the single factor influencing the prognosis of patients with chronic severe hepatitis B was as follows ： PTA 〈 20% , AST/ALT 〉 1.2, TBil 〉 513 μmol/L, ALB 〈 30 g/L, CHO 〈 1.6 mmol/L,CHE 〈4000U/L,PLT 〈50 × 10^9/L and higher serum HBV DNA loads（ HBV DNA ≥13 × 10^4 copies/ml in HBeAg negative patients and ≥1 × 10^5 copies/ml in HBeAg positive patients）. Those eight indexes mentioned above were associated with poor prognosis. Through Logistic regression, five indexes as PTA 〈 20% , ALB 〈 30g/L, CHO 〈 1.6 mmol/L, PLT 〈 50 × 10^9/L and higher serum HBV DNA loads were independent predictable factors of poor prognosis of patients with chronic severe hepatitis B. Those regression coefficients were 1. 731,2. 153,1. 872,2. 375 and 2. 134,respectively. Conclusions Eight single factors and five multi - factors of test indexes showed that prognosis of patients with chronic severe hepatitis B was bad,especially higher serum HBV DNA loads and lower platelets count affected the prognosis should be attented for laboratorian and clinician,while AFP had no impact on the prognosis.