乙型肝炎慢加急性肝功能衰竭中期并发肝性脑病的危险因素分析

Risk factors for the presence of hepatic encephalopathy in patients with hepatitis B virus-related acute-on- chronic liver failure in the mid-phase

目的探讨HBV相关慢加急性肝功能衰竭（ACLF）中期并发肝性脑病的危险因素，便于临床预防干预。方法287例HBV相关ACLF中期患者作为研究对象，应用Logistic回归分析对年龄、性别、糖尿病、肝硬化、上消化道出血、自发性细菌性腹膜炎、肺部感染、Alb、球蛋白、TBil、ALT、AsT、7-T、碱性磷酸酶、总胆固醇、胆碱酯酶、血Cr、PTA、国际标准化比值、甲胎蛋白、HBVDNA载量、血钾、血钠、WBC、PLT等临床指标进行单因素和多因素分析。结果多因素Logistic回归分析显示，血清钾（B=2．006，P=0．000，0R-0．135，95％CI：0．051～0．353）、血清钠（B--0．096，P-0．014，OR-0．908，95％CI：0．841～0．981）、肺部感染（B=1．648，P-0．018，OR-5．199，95％CI：1．326～20．386）、甲胎蛋白（B=．010，P-0．024，OR-0．990，95％CI：0．982～0．999）与肝功能衰竭患者发生肝性脑病相关。结论低钾血症、低钠血症、肺部感染、甲胎蛋白不升高是HBV相关ACI。F中期患者并发肝性脑病的独立危险因素。

Objective To investigate the risk factors for the presence of hepatic encephalopathy in patients with hepatitis B virus （HBV）-related acute-on-chronic liver failure （ACLF） in the mid- phase. Methods A total of 287 patients with HBV-related ACLF in the mid-phase were recruited. Clinical data （age, gender, diabetes, liver cirrhosis, upper gastrointestinal hemorrhage, spontaneous bacterial peritonitis, and pulmonary infection） and laboratory findings l-albumin, globulin, total bilirubin （ TBil）, alanine transaminase （ ALT）, aspartate aminotransferase （AST）, glutamyl transpeptidase （ y-GT ）, alkaline phosphatase, total cholesterol, cholinesterase, creatinine, prothrombin activity （PTA）, international normalized ratio, alpha-fetoprotein （AFP）, loads of HBV DNA, serum potassium, serum sodium, white blood cell, and platelet count] were included as potential risk factors and analyzed with univariate and multivariate Logistic regressions. Results Multiple Logistic regression analysis indicated that serum potassium（B = -- 2. 006, P ： 0. 000, OR = 0. 135,95CI：0. 051--0. 353）, serum sodium（B=-0. 096,P=0. 014,OR=0. 908,95CI：0. 841-- 0. 981）, pulmonary infection （B = i. 648, P = 0. 018, OR 5. 199,95 % CI ： I. 326 -- 20. 386 ）, AFP （B= --0. 010, P = 0. 024, OR = 0. 990, 95% CI：0. 982--0. 999） were correlated with hepaticencephalopathy. Conclusion Hypokalemia, hyponatremia, pulmonary infection and low levels of AFP are independent risk factors of the presence of hepatic encephalopathy in patients with HBV-related ACLF in the mid-phase.