365例重型肝炎预后影响因素的临床分析

The clinical analysis on factors influencing the prognosis of severe hepatitis in 365 cases.

目的探讨重型肝炎预后的影响因素。方法对365例重型肝炎临床资料进行回顾性分析。结果（1）单纯的HBV感染是重型肝炎的主要病因,重叠病毒感染（HBV＋HCV和/或HBV＋HEV）均加重病情;（2）重型肝炎好发年龄主要分布于（20～60）岁,年龄越大,病死率越高,60岁老年患者病死率达74.5%,预后与性别无关;（3）重型肝炎病死率为54.8%,其中急性重型肝炎,亚急性重型病毒性肝炎及慢性重型病毒性肝炎病死率分别为83.3%,64.3%和53.0%;（4）预后与不同水平凝血酶原活动度、总胆红素、血清白蛋白、空腹血糖、血胆固醇及有无胆酶分离密切相关,但与总胆汁酸无显著相关;（5）93.1%重型肝炎患者合并并发症,并发症（肝性脑病、自发性腹膜炎、电解质紊乱、消化道出血、肝肾综合征及其它感染）是影响重型肝炎预后的重要因素,并发症越多,病死率越高。结论年龄、病因、临床分型、多个生化指标、凝血功能及并发症均能影响重型肝炎的转归,性别、总胆汁酸与重肝预后无明显关联。

Objective To explore the factors influencing the prognosis of severe hepatitis （SH）. Methods Clinical data of 365 patients with SH were analyzed retrospectively. Results （ 1 ） simple HBV infection is main cause of SH, superinfection （ HBV ＋ HCV and/or HBV ＋ HEV） could make disease markedly heavier; （ 2 ） SH mainly prevalence on 20 - 60 years of age, the more elder, the higher fatality rates. Fatality rate was 74. 5% in patients at age older than 60, the prognosis of SH had no relation to sexuality ; （3） Fatality rate of SH was 54. 8 %. Fatality rate of acute SH, subacute SH and chronic SH was 83.3% , 64. 3% and 53.0% respectively; （4） Prognosis of SH were closely related to the different levels of prothrombin active, total bilirubin, serium albumin, blood glucose, total cholesterin and bilirubin - enzyme segregation, had no relation to serum total bile acid ; （ 5 ） 93.1% SH patients had complications （ hepatic encephalopathy, spontaneous bacterial peritonitis, disorder of electrolyte, gastrointestinal hemorrhage, hepatorenal syndrome and other infections）, which were important factors influencing the prognosis of severe hepatitis （ SH）, the more complications, the higher fatality rates. Conclusion Age, etiological factor, clinical type, biochemistry parameters, blood coagulation function and complications could influence survival rate of SH, the prognosis of SH had no relation to sexuality and serum total bile acid.