儿童急性肝衰竭并发出血的危险因素

Risk Factors for Pediatric Acute Liver Failure Complicated with Bleeding

目的:分析儿童急性肝衰竭(PALF)并发出血的危险因素,为临床治疗决策提供参考。方法:采用回顾性研究方法,收集重庆医科大学附属儿童医院2014-2020年收治住院的308例PALF患儿的病历资料,分为并发出血组85例和未并发出血组223例,分析并发出血的危险因素。结果:308例PALF患儿中,85例(27.60%)并发出血,9例(2.92%)自发性出血。单因素分析显示,两组患儿感染、肝肾综合征(HRS)、多器官功能障碍综合征(MODS)、年龄、血小板(PLT)、凝血酶原时间(PT)、国际标准化比值(INR)、纤维蛋白原、D-二聚体、天冬氨酸氨基转移酶(AST)等比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄大(OR=1.01,95%CI 1.00~1.02)、感染(OR=7.63,95%CI 3.35~17.39)、HRS(OR=3.12,95%CI 1.38~7.08)、MODS(OR=12.36,95%CI 2.95~51.83)是PALF并发出血的独立危险因素(P<0.05)。结论:PALF自发性出血风险较低,但合并感染、HRS和MODS时出血风险较高。PT和INR等指标不能独立预测PALF的出血风险,还需更完善的凝血指标评价系统。

Objective:To analyze the risk factors for pediatric acute liver failure(PALF)complicated with bleeding,so as to provide basis for clinical treatment decisions.Methods:Medical records of 308 children with PALF hospitalized in Children’s Hospital of Chongqing Medical University from 2014 to 2020 were retrospectively collected.All patients were divided into the complicated bleeding group and the uncomplicated bleeding group according to the presence or absence of bleeding,and the incidence of complicated bleeding and its risk factors were analyzed.Results:Among the 308 children with PALF,85 cases(27.60%)had bleeding and 9 cases(2.92%)had spontaneous bleeding.Univariate analysis showed that infection,hepatorenal syndrome(HRS),multiple organ dysfunction syndrome(MODS),age at diagnosis,platelet count(PLT),prothrombin time(PT),international normalized ratio(INR),fibrinogen,D-dimer and aspartate aminotransferase(AST)were statistically significant in two groups(P<0.05).Multifactorial Logistic regression analysis showed that age(OR=1.01,95%CI:1.00-1.02),infection(OR=7.63,95%CI:3.35-17.39),HRS(OR=3.12,95%CI:1.38-7.08)and MODS(OR=12.36,95%CI:2.95-51.83)were independent risk factors for PALF complicated with bleeding(P<0.05).Conclusion:Children with acute liver failure have a lower risk of spontaneous bleeding.The risk of bleeding is relatively high in combination with infection,HRS and MODS.Coagulation indicators such as PT and INR cannot independently predict the risk of bleeding,and a better coagulation evaluation system is required in PALF.