慢加急性肝衰竭患者预后影响因素分析

Analysis of prognostic factors in patients with acute-on-chronic liver failure

(1)目的探讨降钙素原(procalcitonin,PCT)及其他因素与慢加急性肝衰竭(ACLF)患者预后的关系。(2)方法回顾性分析2013年1月~2015年12月北京佑安医院人工肝中心收治的121例ACLF患者的临床资料,观察3个月评判预后;根据预后将其分为治疗有效组(59例)和无效组(62例)。统计患者的一般资料及常规化验、肝功能等临床检验指标,采用SPSS 18.0软件包对数据进行分析,分析各项指标与预后的关系。将有差异的各项因素进行非条件Logistic回归分析,确定其独立的预后因素。(3)结果 121例ACLF患者中男100例(占82.6%),女21例(占17.4%),平均年龄(48.26±12.15)岁。治疗有效59例,治疗无效62例。经单因素Logistic回归分析发现:年龄、前白蛋白(PAlb)、胆汁酸(TBA)、胆碱酯酶(CHE)、血尿素氮(BUN)、血肌酐(Cr)、凝血酶原活动度(PTA)、凝血酶原时间国际标准化比值(INR)、甲胎蛋白(AFP)、降钙素原(PCT)、白细胞(WBC)、平均血小板体积(MPV)、血小板分布宽度(PDW)均有统计学意义(P<0.1)。转归预后以临床好转为0,无效死亡赋值为1,将单因素Logistic回归筛选出有统计学意义的13个自变量纳入多元Logistic回归分析,对其行非条件Logistic回归发现:PCT、PDW、年龄、AFP、WBC有统计学意义(P<0.05);PCT(P=0.047 OR=1.414)、PDW(P=0.010OR=6.233)、年龄(P=0.050OR=2.846)为预后独立危险因素。PCT、PDW、年龄越高,预后越差。(4)结论 PCT、PDW、年龄是ACLF患者预后的独立危险因素。

Objective To explore the relationship between procalcitonin （PCT） and other factors in the prognosis of patients with acute-on-chronic liver failure（ACLF）.Methods The clinical data of 121 patients with ACLF admitted to Beijing Youan Hospital from January 2013 to December 2015 were analyzed retrospectively, and the prognosis was evaluated for 3 months according to the prognosis of 121 ACLF patients were divided into effective group （59 cases） and ineffective group （62 cases）. The general data of patients, routine laboratory tests, liver function indicators and other indicators were analyzed by SPSS18.0 software package. The different factors were analyzed by unconditional logistic regression to determine the independent prognostic factors. Results A total of 100 cases were male （accounting for 82.6%）, 21 cases were female （accounting for 17.4%）in 121 cases of ACLF patients. The average age （48.26 % 12.15） years old. There were 59 cases in the effective treatment, and the other in the ineffective treatment BUN, CR, PTA, INR, AFP, PCT （ n = 62）. Logistic regression analysis showed that age, PALB, TBA, , WBC, MPV, PDW were statistically significant （ P〈 0.01）. Theprognosis was clinically improved to 0, and the null mortality was assigned to 1, and univariate logistic regression was used to select the 13 independent variables of multivariate logistic. PCT, PDW, age, AFP, WBC were statistically significant, PCT,PDW and age were the independent risk factor related to prognosis of ACLF. The higher of PCT,PDW and age, the worse the prognosis.Conclusion PCT, PDW, age are the independent risk factors for ACLF prognosis