肝硬化患者肝性脑病发生风险的回顾性研究

Risk factors for hepatic encephalopathy in patients with liver cirrhosis: a retrospective study

目的探讨肝硬化患者发生肝性脑病的危险因素。方法选取本院2016年6月至2018年6月确诊为肝性脑病的188例肝硬化患者作为病例组,且以1∶1的比例采用随机数字表抽取同期188例肝硬化无肝性脑病患者作为对照组,分析两组肝硬化患者发生肝性脑病的危险因素。结果单因素分析发现两组病因、肝性脑病病史、肝衰竭、高蛋白饮食、腹膜炎、败/脓毒血症、碱中毒、低氯血症、低钠血症、总胆红素(TBil)、直接胆红素(DBil)、国际化标准比值(INR)、终末期肝病模型(model for end stage liver disease,MELD)评分等比较,差异具有统计学意义(P<0.05)。多因素分析发现肝性脑病病史、高蛋白饮食、碱中毒、MELD评分是肝硬化患者发生肝性脑病的独立危险因素(P<0.05),前白蛋白是其保护性因素(P<0.05)。结论肝功能严重损害、肝性脑病病史、高蛋白饮食及碱中毒等危险因素可增加肝硬化患者肝性脑病发生风险,应及时进行评估与管理。

Objective To explore the risk factors associated with hepatic encephalopathy in patients with cirrhosis.Methods A total of 188 cirrhotic patients diagnosed with hepatic encephalopathy admitted in our hospital during June 2016 and June 2018 were enrolled and assigned into case group,another 188 cirrhotic patients without hepatic encephalopathy were subjected at a ratio of 1:1 and assigned into the control group.The risk factors for hepatic encephalopathy were analyzed based on the clinical data of the 2 groups of patients.Results Univariate analysis found that there were significant differences among cause of disease,history of hepatic encephalopathy,liver failure,high protein diet,peritonitis,sepsis,alkalosis,hypochloremia,hyponatremia,total bilirubin,direct bilirubin,international normalized ratio,and model for end stage liver disease(MELD)score(P<0.05).And multivariate analysis,alkalosis indicated that history of hepatic encephalopathy,high protein diet,alkalosis,and MELD score were independent risk factors for the hepatic encephalopathy,but prealbumin was a protective factor(P<0.05).Conclusion Serious liver damage,history of hepatic encephalopathy,high protein diet,and alkalosis can increase the risk of hepatic encephalopathy in cirrhotic patients,and they should be evaluated and managed timely.