乙肝肝硬化肝性脑病的相关危险因素分析

Risk Factors of Hepatic Encephalopathy in Patient with Liver Cirrhosis

目的探讨乙肝肝硬化并发肝性脑病的相关危险因素。方法回顾性分析北京大学深圳医院2009年1月至2018年12月治疗的乙肝肝硬化患者547例,记录所有患者的临床资料和实验室检查的相关指标以及肝性脑病的发生情况,综合判断分析肝性脑病发生的相关危险因素。结果在所有研究对象中共有69例患者发生肝性脑病,肝性脑病的发生率为12.61%。经过卡方检验分析发现年龄、病程、高蛋白饮食、腹水、上消化道出血、血清总胆红素、血清白蛋白、血尿素氮、Child-Pugh分级、合并感染、血氨与肝性脑病的发生具有相关性(P<0.05)。Logistic多因素回归分析,发现年龄(P=0.021,OR=6.721)、Child-Pugh分级(P=0.032,OR=2.853)、合并感染(P=0.002,OR=3.783)、上消化道出血(P=0.014,OR=5.317)、血清白蛋白(P=0.022,OR=2.725)和血氨(P=0.005,OR=3.714)是乙肝肝硬化发生肝性脑病的独立危险因素。结论在乙肝肝硬化患者中肝性脑病发生率较高,应当根据相关危险因素采取有针对性措施去除诱因是治疗和预防肝性脑病的关键。

Objective To investigate the correlated factors influencing the morbidity of hepatic encephalopathy.Methods From January 2009 to December 2018547 patients with liver cirrhosis were selected.Clinical data and laboratory parameters of all cases were recoded and the risk factors influencing the prognosis of hepatic encephalopathy were analyzed.Results There were correlation between age,course of disease,high protein diet,ascites,upper gastrointestinal bleeding,serum total bilirubin,serum albumin,serum urea nitrogen,Child-Pugh grading,complicated with infection,blood ammonia and the occurrence of hepatic encephalopathy(P<0.05).Logistic multivariate regression analysis showed that age(P=0.021,OR=6.721),Child-Pugh classification(P=0.032,OR=2.853),complicated with infection(P=0.002,OR=3.783),upper gastrointestinal bleeding(P=0.014,OR=5.317),serum albumin(P=0.022,OR=2.725)and blood ammonia(P=0.005,OR=3.714)were independent risk factors for hepatic encephalopathy in hepatitis B cirrhosis.Conclusion In patients with hepatitis B and cirrhosis,the incidence of hepatic encephalopathy is high,and the key to the treatment and prevention of hepatic encephalopathy is to take pertinent measures to remove the inducement according to the relevant risk factors.