重型病毒性肝炎并发症及影响预后的因素分析

Analysis on the complication and prognosis of severe viral hepatitis

目的 研究重型病毒性肝炎 (重肝 )的并发症及影响预后的主要因素。方法 对 116例重肝的有关临床资料进行统计分析。结果 116例重肝有 88例 (75 9% )存在并发症 ,常见的依次为肝性脑病 (6 8 1% )、上消化道出血 (5 4 2 % )、感染 (48 3% )及肝肾综合征 (31 9% )。存在并发症组死亡率 (80 7% )明显高于无并发症组(14 4% ) ,P <0 0 1,出现肝肾综合征及 3个以上并发症者全部死亡。血清总胆红素越高 ,凝血酶原活性越低、总胆固醇越低 ,其病死率越高 ,甲胎蛋白 (AFP)升高者 ,预后较好。结论 重肝的预后与并发症的出现、总胆红素水平、凝血酶原活性、总胆固醇、甲胎蛋白有关。

Objective To study the complication and the factor affecting prognosis of severe viral hepatitis. Methods To analyse the related clinical data of 116 patients with severe viral hepatitis. Results Of 116 cases complications occurred in 88cases (incidence rate, 68.1%),including hepatic encephalopathy(68.1%),the hemorrhage of upper digestive tract(54.2%),infection(48.3%),and hepato renal syndrome(heyd′s sydrome)(31.9%). The mortality(80.7%) of the patients with complication was higher than those with no complication(14.4%),P<0.01,and with heyd′s syndrome or simultaneously with three types of complications, the patients certainly died. We also found that the higher level of serum total bilirubin, and the lower prothrombin activity or total cholesterol, the higher mortality of patients with severe viral hepatitis, but if the level of α fetoprotein(AFP) increased in serum, the prognosis was better.Conclusion\ The prognosis of the patients with severe viral hepatitis was markedly related to the advent of complications, the level of total bilirubin, the activity of prothrombin, the level of total cholesterol, or α fetoprotein.