肝肾综合征329例预后分析

Prognostic analysis of 329 cases of hepatorenal syndrome

目的分析肝肾综合征(hepatorenal syndrome,HRS)的诱因、临床特点及预后,以提高对本病的认识水平。方法对2004年1月-2009年7月解放军第三○二及解放军第二六○医院收治的329例HRS患者的临床资料进行回顾性分析。主要分析指标有血清Na+、Cr、ALB、PTA和终末期肝病模型(modelforend-stageliver disease,MELD)评分。结果 HRS多发于40～60岁男性,主要发生于乙型肝炎所致的肝硬化、慢性重型肝炎患者。感染(自发性细菌性腹膜炎)及消化道出血为常见诱因。配对t检验显示,HRS发生前后患者血清Na+、Cr、ALB、PTA和MELD评分的变化显著(P均<0.05)。本组患者中好转仅16例(4.86%)。结论 HRS预后极差,好转率<5%;MELD评分变化对HRS患者预后具有一定的预测价值。

Objective To analyze the etiology, clinical features and prognosis of hepatorenal syndrome （HRS） so as to improve clinicians＇ understanding of HRS. Methods Clinical data of 329 patients with HRS admitted to 302 and 260 hospital of PLA from Jan. 2004 to July 2009 were retrospectively reviewed. The main markers observed were serum sodium, creatinine （Cr）, albumin （ALB）, plasma prothrombin activity （PTA） and model for end-stage liver disease （MELD） score. Results HRS was more prevalent among males aged 40-60 and patients with cirrhosis and chronic severe hepatitis due to hepatitis B. HRS was mainly caused by infection （including spontaneous bacterial peritonitis） and alimentary tract hemorrhage. Paired-samples t test showed significant differences in serum sodium, Cr, ALB, PTA and MELD score before and after the occurrence of HRS （P 〈0.05）. Only 16 patients （4.86%） with HRS improved. Conclusions The HRS patients have poor prognosis with the improvement rate of less than 5%. The variation in MELD score may serve as a useful predictor in evaluating the prognosis of HRS patients.