血浆置换治疗肝衰竭病死率的影响因素分析

Analysis of the impact factors on fatality in liver failure therapied by plasma exchange

目的：探讨肝衰竭患者进行单纯血浆置换（PE）治疗病死率的影响因素。方法：回顾性分析876例PE治疗的肝衰竭患者其年龄、性别、病因、临床病型、血生化、抗病毒治疗、并发症等对病死率的影响。结果：①PE治疗肝衰竭患者病死率为21．1％，肝衰竭好发年龄分布于20～50岁，年龄越大，病死率越高（P〈0．01）；②性别对肝衰竭病死率无影响（P〉0．05）；③药物性及重叠／混合性病毒感染所致肝衰竭的病死率高于单纯HBV感染所致肝衰竭（P〈0．05）；④急性、亚急性、慢加急性和慢性肝衰竭的病死率分别为85．0％、11．0％和29．6％；⑤凝血酶原活动度、天门冬氨酸转氨酶／丙氨酸转氨酶比值（ALT／AST）、血清总胆红素、低血糖、低钠血症等与PE治疗肝衰竭的病死率密切相关；⑥抗病毒治疗对乙肝病毒感染所致的肝衰竭病死率影响明显（P〈0．01）；⑦肝肾综合征、肝性脑病、消化道出血和自发性腹膜炎等并发症对肝衰竭病死率的影响显著（P〈0．01）。结论：肝衰竭进行PE治疗的病死率受年龄、病因、临床病型、血生化结果、抗病毒治疗、并发症等因素影响。

Objective： To explore the impact factors on fatality in patients with liver failure to carry out plasma exchange （PE） treatment. Methods： The relationship between fatality and age, sex, etiology, clinical disease type, blood biochemistry, anti-viral treatment, complications, etc. In 876 patients with liver failure therapied by PE were analysed retros pectively. Results： （1）The fatality of liver failure after PE treatment was 21.1%, the age distribution of liver failure tended to 20 - 50 years old, the older, the higher fartality （ P 〈 0. 01 ） ; （2）The sex on the treatment of liver failure had no effect （ P 〉 0. 05 ） ; （3）The liver failure due to drug hepatitis and overlap/mixed virus infection had higher fatality （ P 〈 0. 05 ） ; （4）The fatality of acute, subacnte, slowly add acute （sub-acute） and chronic liver failure were 85.0% , 11.0% , 13.7% and 29. 6% , respectively. Acute liver failure had the highest fatality rate （P 〈0. 01 ） ; （5）PTA, AST/ALT, TBil, hypoglycemia, hyponatremia, were closely related to fatality; （6）Anti-viral therapy on liver failure due to hepatitis B virus infection significantly reduced the fatality （P 〈 0. 01 ） ; （7）Hepatorenal syndrome, hepatic encephalopathy, gastrointestinal bleeding and spontaneous bacterial peritonitis and other complications were significantly affected to fatality in liver failure （ P 〈 0. 01 ） . Conclusion： The fatality of liver failure therapied by PE closely related to age, etiology, clinical disease type, blood biochemical findings, anti-viral treatment, complications, etc. factors.