肝硬化上消化道出血患者并发肝性脑病的危险因素分析

Analysis of risk factors for hepatic encephalopathy in patients with liver cirrhosis with upper gastrointestinal bleeding

[目的]探讨肝硬化上消化道出血患者并发肝性脑病的危险因素,为临床早期干预提供依据。[方法]选取肝硬化并发上消化道出血患者235例,依据是否并发肝性脑病,分为病例组(并发肝性脑病组)93例,对照组(没有并发肝性脑病组)142例。对2组患者的临床资料采用单因素和多因素非条件Logistic回归进行统计学分析,筛选出肝硬化上消化道出血患者并发肝性脑病的危险因素。[结果]单因素分析结果显示:病例组和对照组在WBC、PLT、ALT、ALB、TBIL、BUN、Scr、Na+、AM、PT、肝功能CTP评分、腹水、感染方面比较,P<0.05,差异有统计学意义;多因素非条件Logistic回归分析结果显示:血氨增加(OR=1.237,P=0.042)、肝功能CTP评分增加(OR=1.328,P=0.027)、血肌酐增加(OR=2.427,P=0.039)、腹水增多(OR=1.546,P=0.034)是硬化上消化道出血患者并发肝性脑病的危险因素。[结论]更高的血氨、更高的肝功能CTP评分、更高的血肌酐、更多的腹水是硬化上消化道出血患者并发肝性脑病的独立危险因素。

[Objective] To explore the risk factors of hepatic encephalopathy in patients with upper gastrointestinal hemorrhage due to cirrhosis and to provide evidence for early clinical intervention.[Methods]235 patients with liver cirrhosis complicated with upper gastrointestinal bleeding were divided into case group(hepatic encephalopathy group)93 cases and control group(no hepatic encephalopathy group)142 cases.[Results]Univariate analysis showed that there were significant differences in WBC,PLT,ALT,ALB,TBIL,BUN,Scr,Na+,AM,PT,liver function CTP score,ascites and infection between the two groups(P<0.05).Multivariate unconditional logistic regression analysis showed that increased serum ammonia(OR=1.237,P=0.042),increased liver function CTP score(OR=1.328,P=0.027),increased serum creatinine(OR=2.427,P=0.039),and increased ascites(OR=1.546,P=0.034)were risk factors for hepatic encephalopathy in patients with upper gastrointestinal hemorrhage due to cirrhosis.[Conclusion]Higher serum ammonia,higher liver function CTP score,higher serum creatinine and more ascites are independentrisk factors for hepatic encephalopathy in patients with upper gastrointestinal hemorrhage due to cirrhosis.