肝硬化门静脉高压并发症对预后的影响

The effect of portal hypertension on prognosis in patients with decompensated liver cirrhosis

目的了解门静脉高压各并发症在失代偿肝硬化患者的发生情况和各并发症对患者预后的影响。方法选择失代偿期肝硬化患者的病历资料进行登记和随访，根据随访结果，分析患者门静脉高压并发症的发生情况；利用终末期肝病模型（MELD）公式，计算出MELD值并进行分级，同时计算Child—Turcotte—Pugh（CTP）分级，分别分析CTP分级和MELD分级中门静脉高压并发症发生情况和患者生存状况。利用Kaplan-Meier生存分析方法分析门静脉高压并发症对肝硬化患者生存率的影响。利用χ^2检验和时序性检验比较生存率差别，Cox比例风险回归分析各个并发症对患者生存影响作用的大小。结果在符合条件的322例失代偿期肝硬化患者中，发生食管胃底静脉曲张破裂出血、肝性脑病、大量腹水、自发性腹膜炎、肝肾综合征Ⅰ型和Ⅱ型的患者病死率分别是45．9％、79．4％、66．7％、100％、100％和84．6％。各并发症的发生基本按CTP分级和MELD值的增加而逐渐升高。经过Kaplan-Meier生存分析，除少量和中量腹水外，各并发症对患者生存率的影响，P值均〈0．01，差异均有统计学意义。由Cox回归过程分析出肝性脑病、自发性腹膜炎、肝肾综合征Ⅰ型和Ⅱ型、食管胃底静脉曲张破裂出血和腹水的回归系数分别为0．973、0．928、0．935、0．866、0．464和0．369。结论门静脉高压并发症均能对失代偿期肝硬化患者的预后造成明显影响，其中影响程度最大的是肝性脑病。

Objective To evaluate the effect of portal hypertension on prognosis in patients with decompensated liver cirrhosis. Methods The clinical data of decompensated cirrhosis patients in our hospital, between 2003 and 2006, were retrospected and followed up. Model for end-stage liver disease （MELD） score and Child-Turcotte-Pugh （CTP） classification was calculated using the standard formula. Kaplan-Meier survival analysis was used to compare the mortality in subgroups ranked by the syndromes. Cox proportional hazards regression was used to evaluate the effect of the syndromes on prognosis. Results A cohort of 322 patients was admitted in this study at the end of the follow-up. The mortality of variceal bleeding, hepatic encephalopathy, a large volume ascites, spontaneous bacterial peritonitis, the type Ⅰ and type Ⅱ hepatorenal syndrome was 45.9%, 79.4%, 66.7%, 100%, 100% and 84.6% respectively. On the whole, the occurrence of all the syndromes was correlated with CTP classification and MELD score. Kaplan-Meier survival analysis showed that all of these syndromes, except for low to medium volume of ascites, significantly affected the survival rate （P 〈 0.01）. In Cox regression analysis, all the syndromes were the independent predictors of prognosis, the regression coefficient values of hepatic encephalopathy, spontaneous bacterial peritonitis, type Ⅰ and type Ⅱ hepatorenal syndrome, variceal bleeding and ascites were 0.973, 0.928, 0.935, 0.866, 0.464 and 0.369 respectively. Conclusions The portal hypertensive syndromes have significant effect on the prognosis of the patients with decompensated cirrhosis, hepatic encephalopathy is the worst one.