血小板计数对慢性重型肝炎患者人工肝支持系统疗效的危险因素分析

Platelet count as independent risk factor for efficacy of artificial liver support system in patients with chronic severe hepatitis

目的探讨血小板(PLT)计数对慢性重型肝炎(CSH)患者人工肝支持系统(ALSS)疗效的影响。方法 2015年4月至2017年5月在本院感染科住院期间行ALSS治疗的CSH患者179例,共筛选纳入了136例CSH患者为研究对象,以ALSS治疗是否有效将患者分为观察组(治疗有效者,n=61)和对照组(治疗无效者,n=75),分析比较两组患者临床基本资料,并进行Logistic回归分析。结果 (1)两组患者年龄、起病时间、住院时间、压疮危险因素评分、终末期肝病模型(MELD)评分、肝性脑病、肝肾综合征、自发性腹膜炎、白细胞、血红蛋白、PLT、凝血酶原时间、部分活化凝血酶原时间、国际标准比率、凝血酶原活动度和肌酐差异均具有统计学意义(P <0.05);(2)MELD评分、肝性脑病与PLT计数均为CSH患者ALSS疗效的独立危险因素(P <0.05)。结论 MELD评分、肝性脑病与PLT计数均为CSH患者ALSS疗效的独立危险因素,在内科综合治疗的基础上,临床医生对PLT计数偏低(PLT≤50×109/L)的CSH患者进行ALSS治疗前及时提高PLT计数(使PLT> 50×109/L)有助于其临床预后转归。

Objective To explore the influence of platelet count(PLT)on treatment efficacyof artificial liver support system( ALSS) for chronic severe hepatitis(CSH) patients. Methods This study enrolled 136 CSH patients from 179 hospitalized CSH patients who had been treated with ALSS in the Infectious Diseases Department of our hospital from April 2015 to May 2017. Patients had been divided into the experimental group( effective treatment group,n = 61) and the control group( invalid treatment group,n = 75) in accordance to the effects of ALSS treatment. Basic clinical data wereanalyzedand the logistic regression analysis was adopted. Results The analysis showed that age,pathogenic time,hospitalization time,pressure ulcer risk score,M ELD score,ascites,hepatic encephalopathy,hepatorenal syndrome,spontaneous peritonitis,leukocyte(W BC), hemoglobin(H b), PLT, prothrombin time(P T), partial activation of prothrombin time(A PTT), international standard ratio(INR), prothrombin activity(PTA),and creatinine of two groups were statistically significant(P < 0.05). Logistic regression analysis showed that MELD score,hepatic encephalopathy,and PLT were independent risk factors for the efficacy of ALSS on CSH patients(P < 0.05). Conclusions The MELD score,hepatic encephalopathy and PLT are independent risk factors for the efficacy of ALSS treatment on CSH patients. Timely increase of PLT (PLT > 50 × 10^9/L) before ALSS treatment in CSH patients with low PLT(PLT ≤ 50 × 10^9/L) is conducive to the clinical prognosis.