影响慢性重型肝炎预后的单因素研究——附520例临床分析

Single factor study of prognosis from 520 cases with chronic severe hepatitis

目的 分析影响慢性重型肝炎 (慢重肝 )预后的单因素。方法 使用SPASS及STATA软件 ,对 5 2 0例慢重肝预后的单因素进行分析。结果 ①≥ 4 0岁患者的病死率明显升高 ,差异有非常显著性 (P <0 .0 0 1) ,男、女患者及不同变重的基础患者的病死率差异无显著性 (P >0 .0 5 ) ;②白细胞(WBC)≥ 10 .0× 10 9 L或血小板 <10 0× 10 9/L患者的病死率明显升高 ;③随着AST ALT的比值与血清总胆红素 (TBil)不断升高、出现酶胆分离现象、凝血酶原活动度 (PTA)、血清总胆固醇 (Tc)、血清胆碱酯酶活力及白蛋白 (Alb)不断降低 ,病死率逐渐上升 ;④随着腹水、电解质紊乱及自发性腹膜炎等并发症的增多 ,病死率升高 ,以上在统计学上差异均有非常显著性。结论 ≥ 4 0岁、WBC≥ 10 .0× 10 9/L、血小板 <10 0× 10 9/L、AST ALT的比值、TBil、酶胆分离现象、PTA、Tc、血清胆碱酯酶活力、Alb及并发症等是影响慢重肝预后的重要因素 ,动态监测TBil、PTA、Tc和胆碱酯酶等实验室指标 ,积极防治各类并发症是降低病死率重要措施。

Objective To furthur understand chronic severe hepatitis (CSH) and to improve the level of diagnosis and treatment and to explore the methods to reduce the fatality rate of CSH through analysing the factors related to prognosis of CSH. Methods The factors related to prognosis from 520 cases with CSH were analyzed by SPASS and STATA softwares. Results ① The fatality rate in cases with age ≥ 40 years was higher than that in cases with age <40 years ( P <0.001),there was no significant difference ( P >0.05) in sex and pathogenic basis of CSH; ②The fatality rate rose in cases with WBC≥10.0×10 9 per liter or platelet <100×10 9 per liter; ③The fatality rate increased gradually with the ratio of aspartic aminotransferase to alanine aminotransferase (AST/ALT) and serum total bilirubin(TBil), appearance of deviation of TBil and ALT, decrease in prothrombin activity (PTA), total cholesterol (TC), cholinesterase and albumin (Alb) ( P <0.001). ④The fatality rate increased with appearance of complications such as ascites, electrolyte disturbance, spontaneous peritonitis and so on ( P <0.001).Conclusion The important factors related to prognosis were age ≥40 years, WBC ≥10.0×10 9 per liter or platelet <100×10 9 per liter; the ratio of AST/ALT,TBil,Tc,cholinesterase,Alb and complication,to monitor dynamically laboratory indexes such as TBil,PTA,Tc,cholinesterase and so on and to prevent and cure various complications are important measures to reduce the fatality rate of CSH.