乙型肝炎肝硬化隐匿型肝性脑病的影响因素及预后评价

Factors and prognostic evaluation of covert hepatic encephalopathy in patients with hepatitis B-related cirrhosis

目的探讨乙型肝炎肝硬化患者合并隐匿型肝性脑病(CHE)的影响因素及预后情况,为临床诊断乙型肝炎肝硬化合并隐匿型肝性脑病和改善预后提供理论依据。方法2020年5月—2022年6月期间第九〇九医院诊治乙型肝炎肝硬化患者134例,根据是否存在隐匿型肝性脑病分为CHE组(n=69)和非CHE组(n=65);CHE组患者根据随访期间是否进展为肝性脑病,分为肝性脑病组(n=18)和非肝性脑病组(n=51)。比较CHE组和非CHE组临床资料、隐匿型肝性脑病患者预后情况,对CHE危险因素进行logistic回归分析。结果比较CHE组和非CHE组临床资料可知,CHE组患者年龄、肝性脑病史比例、失代偿期肝硬化比例、肝肾综合征比例、合并感染比例、MELD评分以及肝功能C级比例分别为(58.3±13.1)岁、37.7%、98.6%、5.8%、50.7%、10.5±4.6以及17.4%,显著高于非CHE组的(51.9±12.9)岁、4.6%、53.8%、1.5%、24.6%、7.2±2.5以及1.5%;根据logistic回归分析可知,年龄、MELD评分、肝性脑病史以及肝功能分级是隐匿型肝性脑病的独立危险因素;比较隐匿型肝性脑病患者预后情况可知,肝性脑病组患者肝功能C级比例、肝性脑病史比例以及MELD评分分别为50.0%、61.1%和14.7±6.3,显著高于非肝性脑病组的5.9%、29.4%和9.5±4.2。结论乙型肝炎肝硬化患者合并隐匿型肝性脑病受年龄、肝性脑病病史以及感染等多种因素影响,预后情况与肝功能分级、肝性脑病病史及MELD评分等因素有关,临床应关注上述危险因素,预防患者发生隐匿型肝性脑病,改善患者预后。

Objective To explore factors and prognosis of hepatitis B cirrhosis patients complicated with covert hepatic encephalopathy(CHE),and to provide theoretical basis for clinical diagnosis and prognosis improvement of hepatitis B cirrhosis complicated with covert CHE.Methods Between May 2020 and June 2022,134 patients with hepatitis B cirrhosis were divided into CHE group(n=69)and non-CHE group(n=65).According to the progression of CHE during follow-up,the CHE group was further divided into hepatic encephalopathy(HE)group(n=18)and non-HE group(n=51).The clinical data and prognosis were compared between CHE and non-CHE groups,and logistic regression analysis was used to analyze the risk factors of CHE patients.Results Comparing the clinical data of CHE group and non-CHE group,age,the proportion of HE,decompensated liver cirrhosis,hepatorenal syndrome,complicated infection,the MELD score and the proportion of liver function class C in CHE group were(58.3±13.1)、37.7%、98.6%、5.8%、50.7%、(10.5±4.6)and 17.4%,respectively,which were significantly higher than those in the non-CHE group[(51.9±12.9)、4.6%、53.8%、1.5%、24.6%、(7.2±2.5)and 1.5%(P<0.05)].According to logistic regression analysis,age,MELD score,HE history and liver function grade were independent risk factors of CHE.The proportion of grade C of liver function,the proportion of HE history and MELD score in HE patients were 50.0%、61.1%and(14.7±6.3),respectively,which were significantly higher than those in the non-HE group[5.9%、29.4%and(9.5±4.2)(P<0.05)].Conclusion Patients with hepatitis B cirrhosis complicated with CHE were affected by age,HE history,infection and other factors.Their prognosis were related to liver function grade,HE history and MELD score.Greater clinical attention should be focused on these risk factors to prevent the occurrence of CHE and improve the patients prognosis.