73例重型肝炎临床特点及预后影响因素分析

Analyse related factors of impact and prognosis of 73 cases of severe hepatitis

目的回顾性研究73例重型肝炎临床特点及预后影响因素。方法总结73例重型肝炎患者临床特点，按病因、发病性质分组，回顾性分析肝功、肾功、电解质、PTA等生化指标，肝性脑病、上消化道出血、肝肾综合征、腹水、腹腔感染等合并症情况，进行统计学处理，研究上述因素与预后关系。结果（1）73例重型肝炎中单独HBV感染占65．75％，酒精性肝病5例（6．85％），药物性肝损伤6例（8．22％），戊型肝炎2例（2．74％），自身免疫性肝病2例（2．74％），重叠病因7例（9．59％），其他因素3例（4．11％）；按发病速度、严重程度和基础肝病情况分亚急性12例（16．43％），慢性肝炎基础上11例（15．07％），肝硬化基础上重型肝炎50例（68．49％）；无肝性脑病表现占41．10％，有肝性脑病表现占58．90％；（2）重型肝炎死亡率，以酒精性肝病和重叠因素基础上为66．67％，其次为自身免疫性肝病占50％，HBV相关重型肝炎死亡率为18．75％；73例重型肝炎总体病死率为28．77％，其中肝硬化组死亡率（40％）高于非肝硬化组（4．3％），P=0．002，差别有统计学意义；无肝性脑病重型肝炎死亡率3．33％，有肝性脑病组死亡率46．51％，肝性脑病Ⅲ、Ⅳ期死亡率72．73％；（3）独立样本t检验筛选出可能与死亡相关的9个因素，分别是肝硬化、上消化道出血、肝性脑病、肝肾综合征、血肌酐、总胆红素（TBIL）、直接胆红素（DBIL）、白蛋白（ALB）、血钠，多因素非条件logistic回归分析，得出肝性脑病，血肌酐水平是死亡的危险因素，ALB为保护性因素。结论肝性脑病，血肌酐水平是重型肝炎死亡的危险因素，ALB为保护性因素。核苷酸类似物的应用，是重型乙型肝炎死亡率低至18．75％的丰要原因之一．

Objective A retrospective study was conducted to investigate the clinical features and prognostic factors of 73 cases of severe hepatitis. Methods To summarize clinical features of 73 cases of severe hepatitis, grouping by etiology and pathogenesis. A retrospective analysis was performed to evaluate the relationship between biochemical characteristics （ liver function, renal function, electrolytes, PTA, etc） and complications （ hepatic encephalopathy, upper gastrointestinal bleeding, hepatorenal syndrome, ascites, abdominal infections, etc） and prognosis. Results （1） HBV infection alone accounted for 65.75%. Alcoholic liver disease, drug-induced liver injury, hepatitis E, autoimmune hepatitis, overlapping causes and other factors were five cases （6.85%）, six cases （8.22%）, two cases （2.74%）, two cases （2.74%） , seven cases （9.59%） and three cases （4.11%） respectively. According to the incidence rate,severity and underlying liver condition, subacute hepatitis, cases based on chronic hepatitis and on cirrhosis were 12 cases （16.43%） , 11 cases （15.07%） , 50 cases （68.49%） respectively. Clinical manifestations with or without hepatic encephalopathy accounted for 58.90% or 41.10%. （2） The highest mortality of severe hepatitis was alcoholic liver disease and patients on the basis of overlapping factors （66. 67% ）, followed by autoimmune liver disease（50% ）. The mortality of HBV-related hepatitis was 18.75%. Overall mortality of 73 cases of severe hepatitis was 28.77% , of which cirrhosis group was higher than non-cirrhotic group（40% vs 4.3%, P = 0. 002）. The difference was statistically significant. Patients without hepatic encephalopathy had lower mortality than with hepatic encephalopathy（3.33% vs 46. 51% ）. The mortality of patients with hepatic encephalopathy Stage Ⅲ and 1V was 72.75%. （3） Independent samples t test filtered nine factors associated with death, namely cirrhosis, upper gastrointestinal bleeding, hepatic encephalopathy, hepatorenal syndrome, serum creatinine, total bilirubin （TBIL）, direct bilirubin （DBIL）, albumin （ALB） and serum sodium. The results of multivariate conditional logistic regression analysis indicated that hepatic encephalopathy, serum ereatinine levels were risk factors for death, whereas ALB as a protective factor. Conclusion Hepatic encephalopathy, serum creatinine levels were risk factors for severe hepatitis death, But ALB was protective factor. Nucleotide analogs using was the main reason why the mortality of hepatitis B was as low as 18.75%.