慢加急性肝衰竭前期临床常规预警指标研究

Routine early clinical warning indicators of acute-on-chronic pre-liver failure

目的分析慢加急性肝衰竭前期的临床特征,发掘预警肝衰竭发生的指标,建立基于临床指标的早期肝衰竭预警模型。方法回顾性分析我科2002年5月至2008年4月慢加急性肝衰竭前期病例50例、慢性乙型肝炎重度病例62例,比较其发病诱因、发病特点以及临床常规辅助检查指标变化特征间差异,并通过Logistic回归建立判断肝衰竭发生风险的模型。结果两组病例间性别、发病诱因、黄疸出现时间、有无肝硬化、HBeAg阳性率无显著性差异,CHB重度组患者发病年龄分布范围较大(12～72岁),Pre-ACLF组患者发病年龄较集中(29～69岁),两者有显著差异。首次辅助检查指标中,两组凝血检验指标与TBil存在显著差异。指标的变化速率中,Pre-ACLF组PT、INR、TBil最大增加速率显著高于CHB重度组(P=6.386×10-11、1.905×10-11、0.006 5)。ACLF发生概率的预警模型为P=1/[1+e^-(-2.414+7.687×PT延长速率)],PT最大延长速率每天增加1 s,肝衰竭的风险增加2 179.045倍。结论与CHB重度病例比较,Pre-ACLF病例病变相对较剧烈,主要表现为凝血功能的大幅下降与黄疸的大幅增加。其中PT最大延长速率是预测肝衰竭发生最强的风险因素。

analyzing the clinic Objective To establish the clinical indicators-based early liver failure warning model by al characteristics and digging the early warning indicators of prophase acute-on-chronic liver failure （Pre-ACLF）. Methods Fifty patients with acute-on-chronic pre-liver failure （group A） and 62 pa- tients with severe chronic hepatitis B （group B） were retrospectively analyzed. Their predisposing factors, dis- ease onset characteristics, and routine clinical indicators were compared. A liver failure risk model was estab- lished by logistic regression analysis. Results No significant difference was found in gender, predisposing fac- tors, jaundice-occuring time, liver cirrhosis, and HBeAg positive rate between the two groups. The disease on- set age was 12 to 72 years in group B and 29 to 69 years in group A （ P 〈 0. 05 ）. Blood coagulation function test and serum TBil level were significantly different between the two groups. The PT, INR and TBil levels were significantly higher in group A than in group B （ P 〈 0.05 ）. The incidence of ACLF in the early warning model was P = 1/[ 1 ＋ e^ - （ - 2. 414 ＋ 7. 687 PT rising rate） ]. The maximum rising rate of PT was one second per day and the liver failure risk increased 2 179. 045 times. Conclusion The lesion is relatively severer in pa- tients with prophase Pre-ACLF than in those with severe chronic hepatitis B, which is mainly characterized by dramatic blood coagulation function fall and significant jaundice increase. The maximum rising rate of PT is the strongest risk factor for liver failure.