337例住院肝硬化患者预后相关因素研究

Prognostic Factors in 337 Inpatients with Liver Cirrhosis

目的探讨住院肝硬化患者的临床和生存情况,分析影响其预后的危险因素。方法选取337例肝硬化住院病例,对临床资料进行收集与统计,并随访预后情况,分析临床及实验室相关指标与预后的关系。结果①血清总胆红素、直接胆红素、血肌酐、尿素氮、凝血酶原时间、凝血酶原时间国际标准化比率、血红蛋白、白蛋白、腹水与住院期间预后显著相关。②血清总胆红素、直接胆红素、肌酐、尿素氮、凝血酶原时间、凝血酶原时间国际标准化比率、白蛋白、低密度脂蛋白、胆固醇、血钠、肝性脑病、肝肾综合征、腹水及年龄与5年预后显著相关。③经多因素COX回归分析筛选出8个与5年转归相关的独立影响因素为血清白蛋白、肌酐、尿素氮、总胆红素、凝血酶原时间、低密度脂蛋白和腹水、年龄。④住院期间生存率为89.0%,3个月生存率87.8%,6个月生存率82.2%,1年生存率77.4%,3年生存率59.1%,5年生存率46.9%。结论①较多常用临床指标与肝硬化预后相关,肝功能是决定预后的主要因素。②腹水及年龄亦与5年病死率显著相关。

Objective To study the risk factors for poor prognosis in patients with liver cirrhosis. Methods A total of 337 cirrhosis patients were included in the study. The hospital records were analyzed retrospectively,and all patients were followed up by phone call or mail. The associated clinical and laboratory variables were studied by univariate and multivariate statistical analysis. Results ① The survival rates at 3-months,6-months,1-year,3-years and 5-years after hospitalization were 89.0%,87.8%,82.2%,77.4% 59.1% and 46.9%.② Univariate analysis shows that the factors associated with mortality during hospitalization were serum total bilirubin,direct bilirubin,albumin,creatinine,blood urea nitrogen,hemoglobin,prothrombin time,INR for prothrombin time and encephalopathy,hepatorenal syndrome,ascites,and upper gastrointestinal hemorrhage. ③ Univariate analysis showed that the factors associated with mortality 5-years after enrollment were serum total bilirubin,direct bilirubin,albumin,creatinine,blood urea nitrogen,hemoglobin,prothrombin time,INR for prothrombin time,cholesterol,low density lipoprotein,serum sodium and encephalopathy,hepatorenal syndrome,ascites and age. ④ Multivariate analysis showed that serum albumin,creatinine,blood urea nitrogen,total bilirubin,prothrombin time,low density lipoprotein,ascites and age were independently related to 5-year mortality. Conclusion ① For cirrhotic patients,a number of clinical factors were significantly correlated with mortality in hospital or 5 years after enrollment. The liver function is the main factor for prognosis. ② Ascites and age were also significantly related to 5-year mortality.