儿童肝衰竭185例病因及转归多因素分析

The etiology and multivariate statistical analysis of outcome of 185 children with liver failure

目的探讨近10年来儿童肝衰竭的病因和影响转归的因素。方法应用EXCELL2000、STATA7.0软件及非条件Logistic回归分析解放军第302医院近10年来收治的1个月至16岁185例儿童肝衰竭临床资料。结果(1)急性肝衰竭、亚急性肝衰竭、慢加急性肝衰竭及慢性肝衰竭的病例数及存活率分别为38例,39.5%;65例,46.2%;33例,54.6%;49例,55.1%。(2)各年龄段均有发病,发病例数最多为12～16岁组患儿(54例,29.2%),婴儿组亦不少见(32例,17.3%)。(3)已知病因中前4位的病因分别是药物29例(占15.7%),肝豆状核变性26例(占14.1%),与HBV感染相关疾病25例(占13.5%)及与CMV感染相关疾病25例(占13.5%)。病因未明66例(占35.7%)。4岁以下组儿童病因以巨细胞病毒(CMV)感染为主,4～12岁组以肝豆状变性和药物为主,12岁以上组以乙型肝炎病毒(HBV)感染和药物为主,趋于成人肝衰竭病因。(4)10例患儿(占38.5%)通过肝脏病理提示了病因。(5)多因素分析显示患儿的年龄、凝血酶原活动度(PA)、总胆红素(TBIL)和肝性脑病是影响儿童急性和亚急性肝衰竭预后的最危险因素。结论 (1)儿童肝衰竭病因与年龄有较大的关系。已知病因中前4位的病因分别是药物,肝豆状核变性,与HBV感染相关和与CMV感染相关疾病。尚有一部分病例病因未明。(2)肝脏病理在儿童肝衰竭中仅有一部分能起到提示病因的作用。(3)儿童肝衰竭预后差,生存率低。儿童的年龄、PA、TBIL和肝性脑病是影响儿童急性和亚急性肝衰竭预后的最危险因素。

Objective To analyze the etiology and outcome of liver failure in children. Methods The clinical data of 185 children with liver failure treated in our hospital from 2003.7 to 2013.6 was respectively analyzed by EXCELL 2000, STATA 7.0 and logistic regression. Results （1） Of the 185 children with liver failure, 38 were cases of acute liver failure, 65 of subacute liver failure, 33 of acute-on-chronic liver failure and 49 of chronic liver failure. The surviv- al rates were respectively 39.5%, 46.2%, 54.6% and 55.1%. （2） Morbidity was the highest in 12-16 year-old children （54/185, 29.2% ） and it was not uncommon in infants （32/185, 17.3%）. （3） Etiology diagnosis could be established in drug （29/185, 15.4%）, Wilson disease （26/185, 14.1% ） , hepatitis B virus （25/185, 13.5%）and CMV （25/185, 13.5% ）. Etiology diagnosis was not established in 66 children （35.7%）. CMV infection was the commonest in children under 4 years old; Wilson disease and drug mostly in children aged from 4 to 12 years. Children more than 12 years old with liver failure were infected mainly by hepatitis B virus and drug. （4） Etiology of liver failure was confirmed by liver pathology in 10 children （38.5%）. （5） Multivariate statistical analysis showed that the factors significantly correlated with prognosis of acute and subacute liver failure in children were age, PA, TBIL and hepatic encephalopathy. Conclu- sion （ 1 ） The etiology of liver failure in children is significantly related to age. Drug is the commonest etiology in chil- dren compared with Wilson disease, hepatitis B virus and CMV. There is still unknown pathogeny. （2） Liver pathology plays a role in etiological diagnosis of liver failure in children. （3） The prognosis of liver failure in children is poor and mortality is high. Age, PA, TBIL and hepatic encephalopathy are useful factors affecting the outcome of acute and sub-acute liver failure in children.