慢加急性（亚急性）肝衰竭及慢性肝衰竭预后危险因素分析

Analysis of risk factors affecting the prognosis of （sub） acute-on-chronic liver failure and chronic liver failure

目的探讨慢加急性（亚急性）肝衰竭及慢性肝衰竭预后不良危险因素。方法收集我院近3年收治的慢加急性（亚急性）肝衰竭及慢性肝衰竭患者临床资料；根据预后分为好转组与恶化组；重点分析病程超过1周的122例肝衰竭患者预后不良的危险因素，应用Logistic回归分析得出独立危险因素，构建预后方程，并应用ROC曲线下面积（AUC）评价其对预后的预测效能。结果慢加急性（亚急性）肝衰竭与慢性肝衰竭预后比较差异无统计学意义（P〉0．05）。乙肝病毒感染与非乙肝病毒感染者预后比较差异无统计学意义（P〉0．05）。48例应用核苷类药物的乙肝相关肝衰竭白行停药者预后差（P〈0．05）。恶化组自发性细菌性腹膜炎（SBP）、肝性脑病（HE）、肝肾综合征（HRS）的发生率高于好转组（P〈0．05），基线凝血酶原国际标准化比值（INR）明显高于好转组（P〈0．01），基线血清白蛋白（ALB）、血红蛋白（Hb）、血小板（PLT）水平明显低于好转组（P〈0．05）．对上述因素行Logistic回归分析，发现INR及HE是预后的独立危险因素；Logit（P）〈0．1648者，恶化的可能性为95．1％；INR〈1．75者，好转可能性为76．6％。结论乙肝相关肝衰竭自行停用核苷类药物是预后不良的危险因素。ALB、INR、Hb、PI．T、SBP、HE、HRS的发生影响肝衰竭预后。INR及HE是肝衰竭患者预后不良的独立危险因素。

objective To investigate the risk factors affecting the prognosis of （sub） acute-on- chronic liver failure and chronic liver failure. Methods Clinical data from 122 cases of （sub） acute-on- chronic liver failure and chronic liver failure in recentthree years in our hospital were analyzed retrospec- tively, including clinical classification, causes, age, gender, hepatic cirrhosis, complications, and laboratory results. Correlated degree between those single factors and prognosis was explored. Independent risk factors were explored and a prognostic equation was built by logistic regression analysis. The efficacy of the prog- nostic assessment was examined by AUC. Results There was no significant difference in prognosis be- tween（sub） acute-on-chronic liver failure and chronic liver failure. The difference was not significant in prognosis between hepatitis b virus（HBV） related cases and other cases. Of cases related HBV,48 cases received treatment of nucleoside analogues, and the patients who quit taking drugs optionally had a poor prognosis（P 〈 0.05 ）. The incidence of hepatic encephalopathy （HE）, spontaneous bacterial peritonitis （SBP） ,hepatorenal syndrome（HRS） and the baseline level of international normalized ratio（INR） in de- terioration group were higher than those in improved group（ P 〈 O. 05 ）. The baseline levels of serum albu- min（ALB）, hemoglobin （Hb）, blood platelet （PI,T） in deterioration group were lower than those in im- proved group（ P 〈0.05 ）. Multiple logistic regression analysis indicated that INR and HE were independ- ent risk factors affecting the prognosis of liver failure. Meanwhile, the prognostic equation was built ： Logit （P） = 5. 791-1. 367HE（ yes 1 ,no 0） -3. 456INR ; If Logit （P） less than 0. 1648 ,the possibility of deterio- ration was 95.1% ; If INR less than 1.75,there was a 76.6% chance of improvement. Conclusion Quit- ting nucleoside analogues optionally is a risk factor affecting the prognosis of HBV related liver failure. The baseline levels of serum ALB, INR, HBG, PLT and the incidence of HE, SBP, and HRS are associated with the prognosis of the（sub） acute-on-chronic liver failure and chronic liver failure, and INR and HE are in- dependent risk factors.