影响酒精性肝病预后的危险因素分析

Analysis of risk factors for alcoholic liver disease prognosis

目的探讨影响酒精性肝病预后的危险因素。方法回顾调查141例住院酒精性肝病(包括酒精性肝炎及酒精性肝硬化)患者各种可能影响预后的因素,包括年龄、酒精总摄入量、体质指数(BMI)、AST/ALT比值、GGT、LDH,分析上述各种因素与肝功能受损程度(酒精性肝炎、肝硬化Child-Pugh分级A、B及C)间的关系。结果①酒精性肝炎患者年龄及酒精摄入总量均显著低于酒精性肝硬化患者(P<0.01及P<0.05),但在酒精性肝硬化Child-Pugh各级间无显著差异(P>0.05)。②酒精性肝炎与肝硬化Child-Pugh A级患者间(P>0.05)、酒精性肝硬化Child-Pugh B级与C级患者间的BMI无显著差异(P>0.05),但酒精性肝炎与酒精性肝硬化Child-Pugh A级患者BMI显著高于酒精性肝硬化Child-Pugh B级及C级患者(P<0.05)。③AST/ALT比值与肝功能受损程度呈正相关(r=0.9752,P<0.01)。④LDH水平与肝功能受损程度呈正相关(r=0.9797,P<0.01)。⑤GGT水平在各组间均无显著性差异。结论患者年龄、BMI、酒精总摄入量、AST/ALT比值及LDH均与酒精性肝病的严重程度有一定关系,其中AST/ALT比值及LDH水平可较好地用于评估酒精性肝病患者的预后。

To investigate the risk factors for alcoholic liver disease prognosis. Methods 141 patients with alcoholic liver disease （ALD） were recruited in the study. Patients were classified into 4 groups according to their liver function, included namely alcoholic hepatitis group, alcoholic liver cirrhosis Child-Pugh A group, B group, and C group. Possible risk factors which could affect the prognosis of ALD in these patients were investigated respectively. Possible risk factors studied here included age, total amount of alcohol intake, body mass index （BMI） , AST/ALT ratio, GGT and LDH levels. The relationship between above factors and liver function were analyzed to determine risk factors in ALD. Results①Both the average age and total amount of alcohol intake in hepatitis patients were significantly lower than those in patients with alcoholic liver cirrhosis （P 〈 0.01 and P 〈 0. 05, respectively） , but no significant difference was found among cirrhotic patients in different Child-Pugh stages. ②BMI was found no significant difference neither between hepatitis group and Child-Pugh A stage patients, nor between Child-Pugh B and Child-Pugh C stage patients. But BMI in hepatitis and Child-Pugh A stage patients was much higher than that in Child-Pugh B and Child-Pugh C stage patients （P 〈 0.05）. ③ There was positive correlation between AST/ALT ratio and the damage of liver function （r = 0. 9752, P 〈 0.01 ）. ④ There was positive correlation between LDH levels and the damage of liver function （ r = 0. 9797, P 〈 0.01 ）. ⑤ No significance of GGT levels was found among different groups. Conclusion Patients＇ age,BMI, total amount of alcohol intake, AST/ALT ratio and LDH levels are related to the damage of liver function in ALD, among these factors, AST/ALT ratio and LDH levels are better indexes for evaluating the prognosis of ALD.