肝性脑病患者的预后影响因素分析

Logistic regression analysis of prognostic risk factors for hepatic encephalopathy

目的对影响肝性脑病（HE）患者预后的因素进行分析,探讨影响预后的危险因素。方法回顾性分析2006年1月-2014年6月在聊城市人民医院接受治疗的HE患者385例,分为好转组（125例）和恶化组（260例）,选择25个相关临床指标,应用SPSS对相关数据进行非条件二分类反应变量Logistic回归分析。结果经单因素分析,HE分期、上消化道出血、肝肾综合征（HRS）、TBil、国际标准化比值（INR）为影响HE预后的危险因素（P值分别为0.000、0.009、0.047、0.002、0.027）。进一步将有意义的变量进行多因素Logistic回归分析,HE分期、上消化道出血、HRS、TBil、INR为影响HE预后的独立危险因素[P值分别为0.000、0.009、0.000、0.000、0.008,比值比（95%可信区间）分别为4.388（2.997~6.424）、2.805（1.300~6.050）、4.036（2.018~8.072）、1.005（1.003~1.007）、1.446（1.099~1.901）]。结论 HE分期、上消化道出血、HRS、TBil、INR是影响预后的危险因素,HE分期越高、高胆红素、INR越高、出现上消化道出血、HRS时预后差。患者HE分期、上消化道出血、HRS、TBil、INR作为判断HE预后的指标,由此建立的方程对临床治疗有一定的参考价值。

Objective To analyze the prognostic risk factors for hepatic encephalopathy （ HE）, and to explore the risk factors for prognosis. Methods A total of 385 patients with HE who were treated in Liaocheng People＇s Hospital from January 2006 to June 2014 were enrolled in this study and analyzed retrospectively. These patients were divided into improved group （n = 125 ） and deteriorated group （n = 260）. A total of 25 clinical indices were selected, and non - conditional binary logistic regression analysis was performed for related data with SPSS. Results Univariate analysis showed that HE stage, upper gastrointestinal hemorrhage, hepatorenal syndrome （HRS）, total bilirubin （TBil） , and international normalized ratio （INR） were risk factors affecting the prognosis of HE （P = 0. 000, 0.009, 0.047, 0. 002, and 0. 027, respectively）. Multivariate logistic regression analysis was further performed for the variables with statistical significance and the re- sults showed that HE stage, upper gastrointestinal hemorrhage, HRS, TBil, and INR were independent risk factors affecting the prognosis of HE （ P = 0.000, 0.009, 0.000, 0.000, and 0.008, respectively; OR （ 95% CI） = 4. 388 （ 2. 997 - 6. 424）, 2. 805 （ 1. 300 - 6. 050）, 4.036 （2.018-8.072）, 1.005 （1.003-1.007）, and 1.446 （1.099-1.901）, respectively）. Conclusion HE stage, upper gastroin- testinal hemorrhage, HRS, TBil, and INR are risk factors affecting the prognosis of HE, and advanced HE stages, a high level of bilirubin, high INR, and presence of upper gastrointestinal hemorrhage and HRS indicate poor prognosis. The patient＇s HE stage, upper gastrointesti- nal hemorrhage, HRS, TBil, and INR are applied as the indices for prognosis of HE, and the equation based on the these indices may have a reference value in clinical practice.