慢加急性乙型肝炎肝衰竭患者发生感染和急性肾损伤危险因素分析

Risk factors of infection and acute kidney injury in patients with acute-on-chronic hepatitis B liver failure

目的探讨慢加急性乙型肝炎肝衰竭(HBV-ACLF)患者发生感染和急性肾损伤(AKI)的危险因素。方法2017年9月~2019年9月我科收治的HBV-ACLF患者102例,发生感染48例,发生AKI 32例,应用Logistics回归分析影响患者并发感染和AKI的相关影响因素。结果感染组住院天数≥15 d、存在侵入性操作、并发上消化出血、腹水、肝性脑病和糖尿病的比率分别为56.3%、37.5%、43.8%、52.1%、25.0%和16.7%,显著高于未发生感染组的24.1%、13.0%、16.7%、22.2%、5.6%和3.7%(P<0.05),感染组血清总胆红素水平(310.2±42.2)μmol/L,显著高于未感染组【(210.1±2.1)μmol/L,P<0.05】,MELD评分为(26.1±4.6),显著高于未感染组【(20.5±4.1),P<0.05】,血清白蛋白水平为(30.4±1.1)g/L,显著低于未感染组【(35.3±2.0)g/L,P<0.05】;多因素Logistic回归分析显示,住院时间长【OR(95%CI)为1.7(1.3~2.1)】、存在侵入性操作【OR(95%CI)为1.5(1.1~2.1)】、上消化道出血【OR(95%CI)为2.0(1.2~3.2)】和出现肝性脑病【OR(95%CI)为1.8(1.1~2.7)】是HBV-ACLF患者发生感染的独立影响因素;多因素回归分析显示合并糖尿病【OR(95%CI)为1.5(1.2~1.9)】和并发上消化道出血【OR(95%CI)为1.4(1.0~1.9)】是影响HBVACLF患者发生AKI的危险因素。结论HBV-ACLF患者存在容易并发感染和AKI的危险因素,住院时间长,进行侵入性操作和有严重的并发症均需要认真预防和及时处理,才能提高临床救治成功率。

Objective The aim of this study was to explore the risk factors of infection and acute kidney injury(AKI)in patients with acute-on-chronic hepatitis B liver failure(HBV-ACLF).Methods A total of 102 patients with HBV-ACLF were admitted to our hospital between September 2017 and September 2019,and the infections occurred in 48 patients and the AKI occurred in 32 patients.The related risk impacting factors of infection and AKI were analyzed by multivariate Logistic regression analysis.Results The percentages of hospital stay longer than 15 days,invasive check-up,gastrointestinal bleeding,ascites,hepatic encephalopathy and diabetes mellitus in patients with infections were 56.3%,37.5%,43.8%,52.1%,25.0%and 16.7%,significantly higher than 24.1%,13.0%,16.7%,22.2%,5.6%and 3.7%(P<0.05),serum bilirubin level was(310.2±42.2)μmol/L,significantly higher than[(210.1±2.1)μmol/L,P<0.05],the MELD score was(26.1±4.6),significantly higher than[(20.5±4.1),P<0.05],while serum albumin level was(30.4±1.1)g/L,significantly lower than[(35.3±2.0)g/L,P<0.05]in patients without infection;the multivariate Logistic regression analysis showed that the long hospital stay[OR(95%CI):1.7(1.3-2.1)],invasive manipulation[OR(95%CI):1.5(1.1-2.1)],gastrointestinal bleeding[OR(95%CI):2.0(1.2-3.2)]and hepatic encephalopathy[OR(95%CI):1.8(1.1-2.7)]were the independent risk factors for the occurrence of infections in patients with HBV-ACLF;the multivariate Logistic regression analysis demonstrated that the hepatic diabetes[OR(95%CI):1.5(1.2-1.9)]and gastrointestinal bleeding[OR(95%CI):1.4(1.0-1.9)]were the impacting factors for the happening of AKI in patients with HBV-ACLF.Conclusion The patients with HBV-ACLF have some risk factors for complications such as infections and AKI,and the long hospitalization,invasive manipulation,upper gastrointestinal hemorrhage and hepatic encephalopathy are the causative elements,which should be dealt with appropriately to improve the prognosis.