82例急性肝功能衰竭患者临床资料生存分析

Analysis of clinical data and survival rates of 82 patients with acute liver failure

目的 调查分析急性肝功能衰竭 (ALF)的病因、转归及影响因素。方法 回顾性分析我院 1990年～ 2 0 0 1年 11年间ALF临床资料 ,并进行生存分析。结果 ALF共 82例。生存分析显示 ,唯一对ALF患者生存影响有显著意义的临床指标是凝血酶原活动度 (PA ,相对危险度为 2 .661,P =0 .0 0 0 5 )。生存时间由短到长的并发症依次为肝肾综合征 (相对危险度为 14 .776,P =0 .0 2 4)、自发性细菌性腹膜炎 (相对危险度为 5 .70 ,P =0 .0 19)及肝性脑病 (相对危险度为5 .3 18,P =0 .0 0 4)。结论 ALF发病年龄以 12岁～ 40岁青年人群居多 ,最常见的病因是乙型肝炎。药物性肝炎存活率最高。对ALF患者生存影响最具意义临床的实验室指标是PA ,并发肝肾综合征者生存时间最短。

Objective To analyze the causes and prognostic factors of patients with acute liver failure (ALF).Methods Clinical data of 82 hospitalized patients with ALF from 1990 to 2001 were retrospectively analyzed.Results The most common cause was hepatitis B (57.3%), the others were: hepatitis A (14.6%), drug-induced (12.2%),hepatitis E (11.0%) and hepatitis C (4.9%). The total survival rate was 50% of which that due to drug-induced being the highest (100%), and that due to HCV the lowest (25%). The survial rate of ALF due to HEV-, HAV-and HBV was 77.8%, 50% and 36.2%, respectively. The most significant marker for predicting the prognosis of ALF was prothrombin activity, its relative risk ratio (RR) was 2.661 (P=0.0005), and the most common complications were hepatic encephalopathy, electrolyte inbalance, spontaneous bacterial peritonitis, superimpised infections, hepatorenal syndrome and gastrointestinal bleeding. The highest risk of death ALF was hepatorenal syndrome (RR=14.778, P=0.024), the rest were spontaneous bacterial peritonitis (RR=5.7,P=0.019), and hepatic encephalopathy (RR=5.318,P=0.004).Conclusion Most patients with ALF are in the age range of 12～40 years, the most common cause of ALF is hepatitis B. The highest survival rate is drug-induced and the most significant marker for predicting the prognosis is prothrombin activity. The shortest survival period is seen in hepatorenal syndrome.