肝硬化合并显性肝性脑病危险因素的回顾性分析:一项单中心病例对照研究

Retrospective analysis of risk factors of liver cirrhosis combined with overt hepatic encephalopathy:a single-center case-control study

目的探讨肝硬化患者并发显性肝性脑病(OHE)的危险因素。方法回顾性研究设计,以住院肝硬化合并OHE患者为病例组,选取同期住院的肝硬化未发生OHE患者为对照组,比较两组患者临床资料以及实验室资料,分析影响OHE发生的危险因素。应用SPSS软件统计分析,采用t检验或秩和检验比较计量资料,χ^(2)检验或Fisher确切概率法比较计数资料。采用logistic回归进行多因素分析。结果2017年8月至2018年12月期间住院诊断为肝硬化患者共500例,共40例发生OHE,作为病例组,并随机选取40例同期住院的肝硬化未发生OHE患者为对照组。病例组和对照组性别构成和年龄均可比。两组患者的肝硬化病因构成方面,均以病毒性肝炎(其中主要为乙型病毒性肝炎)为主,病例组和对照组分别为52.5%和57.5%。其余病因包括酒精性肝病、自身免疫性肝病等。在血生物化学指标方面,两组的血肌酐水平可比,但是病例组中血清总胆红素水平更高(34.30μmol/L对比18.65μmol/L,Z=-3.185,P<0.05)、血钠水平更低(137.00 mmol/L对比140.08 mmol/L,Z=-2.348,P<0.05)、凝血酶原时间更长(14.60 s对比12.20 s,Z=-5.078,P<0.05),国际标准化比值更低(1.33对比1.07,Z=-5.632,P<0.05),血白蛋白水平更低(30.6 g/L对比35.6 g/L,t=3.386,P<0.05)。在并发症方面,病例组的合并消化道出血比例更高(30.0%对比10.0%,χ^(2)=5.000,P<0.05)、合并腹水比例更高(87.5%对比30.0%,χ^(2)=27.286,P<0.05)、继发感染比例更高(32.5%对比10.0%,χ^(2)=7.813,P<0.05)。在病情严重程度评级方面,病例组的Child-Pugh C级所占比例更高(62.5%对比10.0%,χ^(2)=26.593,P<0.05)。在结局方面,病例组病死3例,对照组无一例病死。多因素分析发现肝硬化患者Child-Pugh分级为C(OR=12.696),合并腹水(OR=10.655)是发生OHE独立危险因素。结论单中心回顾性临床研究显示,肝硬化并发OHE者病情更重,并发症更多。为及时诊治肝硬化OHE,应更多关注合并腹水及Child-Pugh C级者。

Objective To explore the risk factors of overt hepatic encephalopathy(OHE)in patients with liver cirrhosis.Methods A retrospective study was designed.Patients with liver cirrhosis combined with/without OHE who were hospitalized to our hospital during the same period were selected as the case/control group.Clinical and laboratory data of both groups of patients were compared to analyze the risk factors affecting the occurrence of OHE.SPSS software was used for statistical analysis.A t-test or rank-sum test was used to compare the measurement data.Chi-square test or Fisher’s exact probability method was used to compare the count data.Logistic regression was used for multivariate analysis.Results A total of 500 patients with liver cirrhosis diagnosed in our hospital from August 2017 to December 2018 were selected as the case group,and 40 cases with cirrhosis without OHE who were hospitalized during the same period were randomly selected as the control group.The gender composition and age of the case and control group were comparable.Viral hepatitis(mainly hepatitis B)was the main etiology of liver cirrhosis in both groups.There were 52.5%patients in the case group and 57.5%patients in the control group,respectively.Alcoholic liver disease,autoimmune liver disease and so on were the other included causes.With regard to blood biochemical indicators,the serum creatinine levels of both groups were comparable,but in the case group,the serum total bilirubin level was higher(34.30μmol/L vs.18.65μmol/L,Z=-3.185,P<0.05),while the serum sodium level was lower(137.00 mmol/L vs.140.08 mmol/L,Z=-2.348,P<0.05),and the prothrombin time was longer(14.60 s vs.12.20 s)s.078,P<0.05),and international normalized ratio(1.33 vs.1.07,Z=-5.632,P<0.05),and serum albumin level(30.6 g/L vs.35.6 g/L,t=3.386,P<0.05)was lower.In terms of complications,patients in the case group had a higher proportion of combined gastrointestinal bleeding(30.0%vs.10.0%,χ^(2)=5.000,P<0.05),ascites(87.5%vs.30.0%,χ^(2)=27.286,P<0.05)and secondary infection(32.5%vs.10.0%,χ^(2)=7.813,P<0.05).In terms of severity classification,the proportion of Child-Pugh C in the case group was higher(62.5%vs.10.0%,χ^(2)=26.593,P<0.05).In terms of outcome,there were 3 deaths in the case group and no deaths in the control group.Multivariate analysis showed that Child-Pugh class C(OR=12.696),and combined ascites(OR=10.655)were an independent risk factor for OHE in patients with liver cirrhosis.Conclusion Our single-center retrospective clinical study shows that patients with cirrhosis combined with OHE are more critical and have more complications.In order to promptly diagnose and treat OHE,more attention should be paid to patients with combined ascites and Child-Pugh class C.