477例重型病毒性肝炎预后影响因素分析

Analysis on the factors influencing the prognosis of severe hepatitis in 477 cases

目的 通过 4 77例重型病毒性肝炎的临床总结 ,探讨重型病毒性肝炎预后的影响因素。方法 对 4 77例重型病毒性肝炎临床资料进行回顾性分析。结果 急性重型病毒性肝炎 ,亚急性重型病毒性肝炎及慢性重型病毒性肝炎病死率分别为87.5% ,78.7%和 72 .5% ,三者之间无明显差异 ,与性别无关 (P >0 .0 5) ;年龄大于 50岁者病死率为 85.1 % ,预后差 ,但病死组病人血清胆红素 [( 4 0 8.5± 1 0 4 .1 ) μmol/L]、肝性脑病 ( 6 7.1 % )、消化道出血 ( 2 8.0 % )、肝肾综合征 ( 31 .1 % )及严重感染 ( 38.6 % )发生率明显高于好转或治愈组 [( 36 7.4± 1 1 2 .5) μmol/L ,1 8.1 % ,1 3.5% ,0 ,2 1 .3% ,P <0 .0 1 ];凝血酶原活动度 ( 2 5.7%± 7.1 % )明显低于好转或治疗愈组 [( 34 .4± 5.4 ) % ,P <0 .0 1 ]。结论 高龄 ,高胆红素 ,凝血酶原活动度降低并发肝性脑病、消化道出血、肝肾综合征及严重感染是重型肝炎预后不良的因素。

Objective To explore the prognostic factors on patients with severe hepatitis(SH) by analyzing the clinical date of 477 cases with severe viral hepatitis(SH). Methods Clinical data of 477 patients with SH were analyzed retrospectively. Results Fatality rate of acute SH, subacute SH and chronic SH was 87.5%,78.7% and 72.5% respectively. There were no statistical significance among them. Fatality rate in patients with SH had no relation to sexuality. Fatality rate was 85.1% in patients at age older than fifty and they had a poor prognosis. Serum bilirubin (408.5 ±104.1 mol/L), hepatic encephalopathy(67.1%),gastrointestinal hemorrhage (28.0%),hepatorenal syndrome(31.1%)and severe infection (38.6%) in death group were higher than those [(367.4±112.5)μmol/L,18.1%,13.5%,0,21.3% respectively] in curing or improving group ( P <0.01). Prothrombrin activity (PTA) in death group [(25.7±7.1)%] was lower than that [(34.4±5.4)%] in curing or improving group( P <0.01). Conclusion Aged people, high bilirubin, low PTA, and complicated with encephalopathy, gastrointestinal hemorrhage, hepatorenal syndrome and severe infection are bad parameters in patients with SH.