摘要
目的研究不同病因肝硬化失代偿患者的临床特征差异及长期预后的相关危险因素。方法前瞻性入组2014年7月—2017年6月在中国科学院大学宁波华美医院住院的肝硬化失代偿患者643例,评估病因,收集患者临床资料及实验室指标等,比较不同病因肝硬化失代偿患者临床特征,COX生存分析病因对肝硬化失代偿患者长期预后的影响。结果643例肝硬化失代偿患者,2年死亡235例,病死率36.5%,其中乙型肝炎、乙型肝炎合并酒精性肝病、酒精性肝炎、其他病因及不明原因者2年死亡率分别为28.7%(91例)、45%(27例)、40.2%(49例)、42.7%(35例)和53.2%(33例)。相比于乙型肝炎病因患者,酒精性肝炎病因患者年龄大,男性比例高,并发症无明显差异,2年预后稍差(28.7%比40.2%,P<0.05);而不明原因肝硬化患者,年龄最大,女性占比高,细菌感染发生率更高,长期预后最差。COX单因素生存分析发现,影响患者2年病死率的因素包括年龄、平均动脉压(MAP)、糖尿病、肝硬化既往失代偿、病因、腹水、上消化道出血、细菌感染、肝性脑病、谷草转氨酶(AST)、白蛋白(Alb)、总胆红素(TBil)、国际标准化比值(INR)、血钠、白细胞计数(WBC)、血肌酐(Cr)、血小板计数(PLT)及相关预后模型等。进一步进行COX多因素回归分析,结果显示,年龄、病因、血钠、PLT、Alb及终末期肝病模型(MELD)评分入选回归方程,为肝硬化失代偿患者长期预后的重要影响因素。结论乙型肝炎肝硬化失代偿患者长期预后最好,不明原因肝硬化患者预后最差,年龄、病因、血钠、PLT、Alb及MELD评分是影响肝硬化失代偿患者2年预后的独立危险因素。
Objective To study on the clinical characteristics and risk factors of long-term prognosis of patients with decompensated cirrhosis due to different etiologies.Methods Six hundred and forty-three patients with decompensated cirrhosis were prospectively enrolled in this study.Clinical data and laboratory indicators were collected in all patients for identifying the etiologies of liver diseases.The relationship between different etiologies with long-term prognosis were compared and the impact factors for long-term prognosis were analyzed by COX survival.Results Of the 643 patients with decompensated cirrhosis,235 died in 2 years and the mortality was 36.5%.The 2-year mortality rate of HBV related cirrhosis,hepatitis B combined with alcoholic cirrhosis,alcoholic cirrhosis,other etiologies,and cryptogenic cirrhosis was 28.7%45.0%40.2%42.7%and 53.2%,respectively(P value<0.05).Compared with HBV-related cirrhosis,patients with alcoholic cirrhosis were older,male predominant,and higher in 2-year mortality.The cirrhotic patients with unknown etiologies were the oldest,female in majority,with higher incidence of bacterial infection,and the worst long-term prognosis.Univariate COX regression analysis shown that age,mean arterial pressure(MAP),diabetes,previous decompensation,etiology,ascites,upper gastrointestinal bleeding,bacterial infection,hepatic encephalopathy,aspartate aminotransferase(AST),albumin(ALB),total Bilirubin(TBIL),International normalized ratio(INR),serum sodium,white blood cell count(WBC),creatinine(Cr),platelet count(PLT)and the prognostic models were associated with the 2-year mortality.By multivariate COX regression analysis it was found that age,etiology,serum sodium,platelet,albumin and Model for end-stage liver disease(MELD)score were independent risk factors of 2-year mortality in decompensated cirrhosis.Conclusion Patients with HBV related decompensated cirrhosis have the best whereas those with cryptogenic cirrhosis have the worst long-term prognosis.Age,etiology,serum sodium level,platelet count,
作者
杜静园
颜华东
DU Jing-yuan;YAN Hua-dong(Medical College of Ningbo University,Zhejiang 315211,China;Department of Hepatology,Ningbo Hwamei Hospital,Chinese Academy of Sciences,Zhejiang 315010,China)
出处
《肝脏》
2021年第2期140-146,共7页
Chinese Hepatology
基金
浙江省医药卫生科技计划平台项目(2018ZD039)。
关键词
肝硬化失代偿期
病因
临床特征
长期预后
危险因素
Decompensated cirrhosis
Etiology
Clinical characteristics
Long-term prognosis
Risk factors
