慢性重型乙型肝炎预后影响因素研究

Study of effect factors for prognosis of chronic severe hepatitis B

目的探讨影响慢性重型乙型肝炎(CSHB)患者预后的因素,以指导临床实践。方法收集384例CSHB住院患者的相关资料,将患者分为好转组和死亡组,分析2组患者一般人口学资料、临床资料和实验检测资料,应用二元Logistic回归法分析CSHB患者死亡的危险因素。结果 384例CSHB住院患者中死亡162例(42.2%),好转222例(57.8%)。二元Logistic回归分析表明年龄大于50岁、有吸烟史、合并原发性腹膜炎、消化道出血、肝性脑病、其他部位感染、电解质紊乱、肝癌、血清总胆红素(TBil)升高是CSHB患者死亡的高危因素,抗乙肝病毒治疗和凝血酶原活动度(PTA)较高是CSHB的保护因素。结论对于年龄较大的CSHB患者,早期给予抗乙肝病毒治疗,积极预防和及时治疗相关并发症,可能会改善患者的预后。

Objective It is to explore the factors which can effect prognosis of chronic severe hepatitis B（CSHB） to guide clinical practice.Methods Correlated datas of 384 cases of patients with CSHB hospitalized were collected and the subjects were divided into effective group and death group.The demographic and clinical data of the two groups were analyzed and binary Logistic regression modeling was employed to analyze the risk factors predicting CSHB patients＇ deaths.Results There were 162 patients died（42.2%）,and 222 patients improved in all subjects collected above.Binary Logistic regression analysis showed that age older than 50 years,smoking,higher serum TBil,with complications such as primary peritonitis,gastrointestinal hemorrhage,hepatic encephalopathy,other infections,electrolyte imbalance,or liver cancer were risk factors predicting death for CSHB patients,while anti-HBV treatment and higher PTA were the protective factors.Conclusion For CSHB patients,especially those who are older than 50,giving anti-HBV treatment early,preventing and treating complications actively and timely may benefit for the prognosis.