肝衰竭患者转归影响因素的回顾性分析

Retrospective analysis on influencing factors of outcomes patients with liver failure

目的了解影响肝衰竭患者预后的相关因素。方法收集2013年6月至2018年6月西安交通大学第一附属医院收治的247例肝衰竭患者的临床资料,对其性别、年龄、肝衰竭分型及病因、各项实验室检测指标、并发症、治疗及转归情况等进行统计学分析。结果前清蛋白、血清钠、总蛋白、年龄、腹腔积液、伴发感染、肝性脑病、肝肾综合征、消化道出血、国际标准化比值、肌酐、总胆红素等12个变量是肝衰竭预后的影响因素。前清蛋白、血清钠、总蛋白是肝衰竭预后的保护因素[优势比(OR)>1,P<0.05];年龄、腹腔积液、伴发感染、肝性脑病、肝肾综合征、消化道出血、国际标准化比值、肌酐、总胆红素是肝衰竭预后的危险因素(OR<1,P<0.05)。多因素logistic回归模型分析结果显示,患者总胆红素水平越高、血清钠水平越低则预后越差(OR=0.992、1.140,P=0.000、0.007);发生肝性脑病、肝肾综合征患者预后较差(OR=0.063、0.267,P=0.000、0.043)。结论肝衰竭患者的预后受多种因素的影响,这些因素特别是总胆红素、血清钠水平,以及肝性脑病和肝肾综合征等并发症的发生及发展可作为判断肝衰竭患者预后和调整治疗方案的依据。

Objective To understand the related factors affecting the prognosis in the patients with liver failure. Methods The clinical data in 247 cases of liver failure in the First Affiliated Hospital of Xi′an Jiaotong University from June 2013 to June 2018 were collected and statistically analyzed on the sex,age,types of liver failure,etiology,laboratory detection indicators,complications,treatment and prognosis. Results The 12 variables of prealbumin,serum sodium,total protein,age,ascites,complicating infection,hepatic encephalopathy,hepatorenal syndrome,gastrointestinal bleeding,INR,creatinine and total bilirubin were the influencing factors affecting the prognosis of liver failure.Among them,the prealbumin,serum sodium and total protein were the protective factors for the prognosis of liver failure( OR >1, P <0.05);the age,ascites,complicating infection,hepatic encephalopathy, hepatorenal syndrome,gastrointestinal bleeding,INR,creatinine and total bilirubin were the risk factors for the prognosis of liver failure( OR <1 , P <0.05).The multivariate Logistic regression model analysis results showed that the higher the total bilirubin level( OR =0.992, P =0.000),the lower the serum sodium level,and the worse the prognosis( OR =1.140, P = 0.007 ).The patients with hepatic encephalopathy and hepatorenal syndrome had poor prognosis( OR =0.063,0.267, P =0.00, 0.043 ). Conclusion The prognosis of liver failure is influenced by many factors,and these factors,especially the level of total bilirubin and serum sodium,occurrence and development of hepatic encephalopathy and hepatorenal syndrome can be used as the basis for judging the prognosis and adjusting the treatment scheme.