儿童肝衰竭76例临床及预后分析

Analysis of prognosis of pediatric liver failure in 76 cases.

目的总结76例儿童肝衰竭临床资料,探讨影响儿童肝衰竭预后的相关因素。方法选择重庆医科大学附属儿童医院2001年6月至2010年11月收治的76例病历资料,用EXCEL及SPSS18.0软件分析,单因素分析用累积比数logistic回归模型分析,多因素分析用logistic回归模型分析。结果 (1)儿童肝衰竭治疗好转、治愈率低(17.1%)。(2)本组病例病因不明32例(42.1%),病因明确44例(57.9%),胆道畸形、巨细胞病毒、乙型肝炎病毒及EB病毒感染占72.7%。(3)使用非生物型人工肝治疗12例(15.8%),治疗显效2例,有效1例,治疗无效9例。(4)单因素分析提示,年龄、凝血酶原时间活动度(PTA)、白蛋白、肝性脑病、住院时间、并发症的种数对预后的影响有统计学意义(P均<0.05);多因素分析提示,肝性脑病、住院时间是影响患儿预后的独立危险因素(P均<0.05)。结论儿童肝衰竭病情进展快、病死率高,病因不明确占多数,肝性脑病、住院时间是影响患儿预后的独立危险因素。分析各种因素对儿童肝衰竭预后的影响可为疾病的诊断、治疗提供帮助。

Objective To summarize the clinical data of 76 cases pediatric liver failure and analyze the prognostic fac- tors. Methods All of the 76 cases were selected in Children＇ s Hospital Affiliated to Chongqing Medical University from Jun.2001 to Nov.2010,which were analyzed by using EXCEL and SPSS18.0 sofewares;one-factor analysis was done by ordinal regression model.Multifactors were analyzed by logistic regression model. Results （1）The survival rate of liver failure in children was only 17.1%. （2）Etiology was not clear in 32 children （42.1% ）with liver failure;clear in 44 （57.9%） ; 72.7% were caused by congenital biliary malformation, CMV, HBV and EBV infection. （3）Twelve children re- ceived non-biological artificial liver treatment,3 of which survived while 9 had no effect.（4） Univariate analysis showed that the factors significantly correlated with prognosis were age, prothrombin activity, albumin, hepatic encephalopathy, hospital stay and complications. Multivariate analysis showed that the factors significantly correlated with prognosis were hepatic encephalopathy and hospital stay. Conclusion Liver failure in children progresses quickly, whose mortality rate is high and most of which has unknown aetiology. Factors significantly correlated with prognosis are hepatic encepha- lopathy and hospital stay. It is meaningful for diagnosis and treatment to analyze these prognostic factors.