摘要
目的探讨低血糖对老年失代偿期肝硬化住院患者短期预后的影响。方法回顾性纳入2019年1月—2021年1月于西安交通大学第一附属医院收治的因失代偿期肝硬化住院的103例老年肝硬化患者为研究对象,根据6个月内是否存活分为死亡组(n=41)和存活组(n=62),根据是否发生低血糖分为低血糖组(n=28)和无低血糖组(n=75)。收集患者的临床和实验室检查资料,分析老年失代偿期肝硬化患者6个月内死亡的相关危险因素,并通过二元Logistic回归构建风险模型,通过受试者工作特征曲线评估该模型的效能。结果与存活组比较,死亡组肝硬化腹水发生率、上消化道出血发生率、Child-Pugh评分、总胆红素水平、INR和血钠水平显著升高,白蛋白和血红蛋白水平显著下降(P均<0.05);死亡组发生低血糖比例明显高于存活组(39.02%vs19.35%,χ^(2)=4.82,P=0.03)。与无低血糖组相比,低血糖组Child-Pugh评分显著升高(P<0.05)。上消化道出血、Child-Pugh评分升高、INR升高、血红蛋白降低以及低血糖是影响患者6个月内生存状态的危险因素。本研究所构建的风险模型鉴别患者6个月内死亡的曲线下面积为0.73,敏感性和特异性分别为68.3%和79.0%。结论老年失代偿期肝硬化患者的低血糖反应与6个月内预后不良有关,应加以重视。
Objective To study theeffects of hypoglycemia on short-term prognosis of elderly hospitalized patients with decompensated cirrhosis.Methods A total of103hospitalized elderly patients with decompensated cirrhosisadmitted to First Affiliated Hospital of Xi’an Jiaotong University from January2019to January2021were retrospectivelyincluded as the research subjects.They were divided into death group(n=41)and survival group(n=62)according to whether they survived within6months;they were divided into hypoglycemia group(n=28)and non-hypoglycemia group(n=75)according to the occurrence of hypoglycemia.The clinical and laboratory examination data of these patients were collected and the related risk factors of death within6months were analyzed.The risk model was constructed by binary Logistic regression,and the efficiency of the model was evaluated by receiver operating characteristic curve.Results Compared with the survival group,the incidence of liver cirrhosis ascites,the incidence of upper gastrointestinal bleeding,Child-Pugh score,total bilirubin level,INR and serum sodium levels in the death group were significantly increased,while the levels of albumin and hemoglobin were significantly decreased(all P<0.05).The incidence of hypoglycemia in the death group was significantly higher than that in the survival group(39.02%vs19.35%,χ^(2)=4.82,P=0.03).Compared with the non-hypoglycemia group,the Child-Pugh score of the hypoglycemia group was significantly higher(P<0.05).Upper gastrointestinal bleeding,increased Child-Pugh score,increased INR,decreased hemoglobin,and hypoglycemia were risk factors affecting the survival status of patients within 6 months.The area under the curve of the risk model constructed in this study to identify the death of patients within 6 months was 0.73,and the sensitivity and specificity were 68.3%and 79.0%,respectively.Conclusion Hypoglycemia in elderly patients with decompensated cirrhosis is related to poor prognosis within 6 months,which should be paid attention to.
作者
杨鑫
刘小静
王丽
李洁洁
张佳丽
武珊珊
Yang Xin;Liu Xiaojing;Wang Li;Li Jiejie;Zhang Jiali;Wu Shanshan(First Affiliated Hospital of Xi’an Jiaotong University/Clinical Research Center for Infectious Diseases of Shaanxi Province,Xi'an,Shaanxi,710061,P.R.China)
出处
《老年医学与保健》
CAS
2022年第3期627-631,共5页
Geriatrics & Health Care
基金
陕西省科技厅自然科学基础研究计划(2017JM8083)。
关键词
老年
低血糖
失代偿期肝硬化
预后
风险模型
elderly
hypoglycemia
decompensated cirrhosis
prognosis
risk model
