慢性重型乙型病毒性肝炎患者预后影响因素分析

Predictors of prognosis of patients with chronic severe hepatitis B

目的探索影响慢性重型乙型病毒性肝炎(乙肝)患者预后的因素,为临床护理工作提供依据。方法回顾性调查202例慢性重型乙肝患者的电子病历,根据治疗效果将患者分为治疗有效组和治疗无效组,从年龄、性别、职业、乙肝家族史、既往饮酒史、抗病毒治疗、发病诱因、基础疾病及并发症等方面进行单因素分析及多因素回归分析,探索影响其预后的主要因素。结果202例慢性重型乙肝治疗有效130例,治疗无效72例,并发肝性脑病(OR=11.936)、抗病毒治疗(OR=4.257)、乙肝家族史(OR=3.678)及并发肝肾综合征(OR=4.707)是治疗无效的强预测因子(均P<0.01)。结论慢性重型乙肝合并肝性脑病或肝肾综合征者,以及未接受抗病毒治疗、无乙肝家族史者预后较差。医护人员应早期发现肝性脑病、肝肾综合征,加强此类患者的抗病毒药物相关知识教育,强调抗病毒药物的远期效果,建立长期随访机制,提供院外护理指导,保证抗病毒药物的正规应用,督促患者定期复查,是改善预后的重要措施。

Objective To analyze the predictors of prognosis of patients with chronic severe hepatitis B, and to provide basis for clinical nursing care. Methods A total of 202 patients with chronic severe hepatitis B were divided into an effective group and an ineffec tive group according to treatment results. Their medical charts were reviewed and such data as ages, genders, jobs, family history of hepatitis B, history of alcohol consumption, antiviral therapy, predisposition to disease onset, underlying conditions, complica- tions, etc, were retrieved and went through univariate analysis and multivariate regression analysis. Results Among 202 patients with chronic severe hepatitis B, 130 responded to treatment and 72 failed. Factors that strongly predicted the failure of treatment included development of the complication of hepatic encephalopathy （OR=11. 936） ,not receiving antiviral therapy （OR=4. 257）, family history of hepatitis B （OR=3. 678）, and development of the complication of hepatorenal syndrome （OR=4. 707） ,with sta-tistical significance being found （P〈0.01 for all）. Conclusion Patients with chronic severe hepatitis B, if complicated with hepatic encephalopathy, or hepatorenal syndrome, or not receiving antiviral therapy, or not having a family history of chronic hepatitis B, tend to have poor prognosis. Medical staff should recognize early signs of hepatic encephalopathy and hepatorenal syndrome, strengthen health education to these patients, put emphasis on long term effect of antiviral therapy, build a long term follow-up program, provide out-of-hospital service, guarantee the regular use of antiviral agents, and urge patients to go for check-up regu- larly. Only in this way could patients prognosis be improved.