布加综合征患者死亡相关影响因素分析

Influencing Factors of Mortality in Patients with Budd-chiari Syndrome

目的分析布加综合征(BCS)患者死亡的相关影响因素。方法纳入2008年1月—2012年12月在徐州医学院附属医院介入科住院的BCS患者449例,通过查阅病历收集临床相关资料,并对其行随访调查了解预后情况。采用多因素Logistic回归模型分析其死亡相关影响因素。结果 449例BCS患者死亡32例;单因素分析显示,未死亡组和死亡组患者腹胀、乏力、腹腔积液、黄疸、肝性脑病等因素间差异有统计学意义(P<0.05);Logistic回归模型分析显示肝癌〔OR=72.167,95%CI(11.096,469.363),P<0.05〕、白细胞计数〔OR=1.256,95%CI(1.078,1.463),P<0.05〕、总胆红素〔OR=1.029,95%CI(1.010,1.463),P<0.05〕、不手术〔OR=9.664,95%CI(1.709,54.640),P<0.05〕、生闷气〔OR=3.729,95%CI(1.029,13.512),P<0.05〕、腹腔积液〔OR=41.842,95%CI(2.956,592.191),P<0.05〕和肝性脑病〔OR=32.369,95%CI(1.971,531.439),P<0.05〕为死亡的危险因素。结论存在肝癌、消化道不适、腹腔积液、肝性脑病,白细胞计数、总胆红素水平升高及生闷气、未手术的BCS患者病死率高,需高度重视,应采取相应的措施降低其病死率。

Objective To study the risk factors for death of patients with Budd - Chiari syndrome （BCS）. Methods Totally 449 BCS patients treated in the hospital affiliated to Xuzhou Medical College from January 2008 to December 2012 were included in this study. Data retrieved from the medical archives served as the baseline. The data of the prognosis of each patient was collected through follow - ups. Logistic regression analysis was used to explore risk factors for death. Results Among 449 cases of BCS, 32 patients died; univariate analysis indicated that there was significant difference in the incidence rates of abdom- inal distension, fatigue, ascites, jaundice, hepatic encephalopathy and other 20 factors between the death group and the surviv- al group （P 〈0. 05）. Logistic regression analysis revealed that hepatocellular carcinoma [ OR = 72. 167, 95% CI （ 11. 096, 469. 363）, P 〈 0. 05 ], and white blood cell count [ OR = 1. 256, 95% CI （ 1. 078, 1. 463 ）, P 〈 0.05 , total bilirubin [0R=1.029, 95%C1 （1.010, 1.463）, P〈0.053, no surgery [OR=9.664, 95%C/ （1.709, 54.640）, P〈0.05, frequent sulks [OR=3.729, 95%CI （1.029, 13.512）, P〈0.05], ascites OR=41.842, 95%C/ （2.956, 592.191）, P 〈0. 05 , hepatic encephalopathy [ OR = 32. 367, 95% CI （ l. 971, 531. 439 ）, P 〈 0. 05 , were the risk factors for the mortality of BCS. Conclusion The BCS patients with hepatocellular carcinoma, ascites, hepatic encephalopathy, higher levels of white blood cell and total bilirubin, frequent sulks and receiving no interventional therapy had higher fatality rate, which re- quires great attention. Relative interventions should be made to reduce the fatality rate.