摘要
目的 分析肝硬化失代偿期(DLC)继发肝性脑病的危险因素及预后.方法 回顾性选择2019年1月至2022年1月在北京市大兴区人民医院诊治的131例DLC患者作为研究对象,根据患者是否继发肝性脑病分为肝硬化失代偿期组(DLC组)和DLC继发肝性脑病组(DLC+HEC组).分析并比较DLC组和DLC+HEC组患者临床资料的差异.单因素和多因素Logistics回归分析DLC继发肝性脑病的危险因素.采用受试者工作特征(ROC)曲线分析预测DLC继发肝性脑病1年死亡的敏感度及特异度.结果 DLC+HEC组患者的年龄、住院时间、ALT、AST、TBIL、APACHEⅡ 评分、Child-Pugh 分级 C 级比例及血氨分别为(64.5±8.2)岁、(18.7±2.6)d、(98.1±8.5)U/L、(82.4±7.3)U/L、(23.9±3.2)分、60.00％、(72.1±8.3)µmol/L,均显著高于 DLC 组[(57.4±7.5)岁、(11.5±1.8)d、(71.4±7.2)U/L、(67.1±6.6)U/L、(17.3±3.5)分、18.60％、(54.4±6.9)μmol/L],差异均有统计学意义(P＜0.05).单因素Logistics回归分析发现患者年龄、ALT、AST、TBIL、APACHE Ⅱ评分、Child-Pugh分级及血氨与肝DLC继发肝性脑病风险显著相关(P＜0.05).多因素Logistics回归分析发现年龄、APACHE Ⅱ评分、Child-Pugh分级及血氨为DLC继发肝性脑病的独立危险因素(P＜0.05).年龄预测DLC肝性脑病1年死亡截断值为66.7岁,敏感度为0.823,特异度为0.793;APACHE Ⅱ评分预测DLC肝性脑病1年死亡截断值为24.5分,敏感度为0.807,特异度为0.756;Child-Pugh分级预测DLC肝性脑病1年死亡截断值C级,敏感度为0.782,特异度为0.824;血氨预测DLC肝性脑病1年死亡截断值为75.3 μmol/L,敏感度为0.855,特异度为0.863.结论 年龄、APACHE Ⅱ评分、Child-Pugh分级及血氨为DLC继发肝性脑病的独立危险因素,且与患者预后相关.年龄≥66.7岁、APACHE Ⅱ评分≥24.5分、Child-Pugh分级C级及血氨≥75.3 μmol/L提示预后不良.
Abstract
Objective To analyze the risk factors and prognosis of secondary hepatic encephalopathy in decompensated liver cirrhosis(DLC).Methods A total of 131 patients with decompensated liver cirrhosis diagnosed and treated in Beijing Daxing District People's Hospital from January 2019 to January 2022 were retrospectively selected as the research objects.According to whether the patients had secondary hepatic encephalopathy,they were divided into the DLC group and the DLC secondary hepatic encephalopathy group(DLC+HEC group).The differ-ences in the clinical data of patients in the DLC group and the DLC+HEC group were analyzed and compared.The risk factors of secondary hepat-ic encephalopathy in decompensated liver cirrhosis were analyzed by univariate and multivariate Logistic regression analysis.Receiver operating curve(ROC)analysis was used to predict the sensitivity and specificity of 1-year mortality in patients with decompensated liver cirrhosis seconda-ry to hepatic encephalopathy.Results The age,length of hospital stay,ALT,AST,TBIL,APACHE Ⅱ score,the proportion of Child-Pugh grade C,and blood ammonia in the DLC+HEC group were(64.5±8.2)years old,(18.7±2.6)days old,(98.1±8.5)U/L,(82.4±7.3)U/L,(23.9±3.2)points,60.00％,and(72.1±8.3)μmol/L,respectively,which were significantly higher than those in the DLC group[(57.4±7.5)years old,(11.5±1.8)days,(71.4±7.2)U/L,(67.1±6.6)U/L,(17.3±3.5)points,18.60％,(54.4±6.9)]μmol/L,the differences were statistically significant(P＜0.05).Univariate Logistic regression analysis found that age,ALT,AST,TBIL,APACHE Ⅱ score,Child-Pugh grade,and blood ammonia were significantly correlated with the risk of secondary hepatic encephalopathy in de-compensated liver cirrhosis(P＜0.05).Multivariate Logistic regression analysis found that age,APACHE Ⅱ score,Child-Pugh grade and blood ammonia were independent risk factors for secondary hepatic encephalopathy in decompensated cirrhosis(P＜0.05).Age predicted the 1-year death cut-off value of cirrhosis decompensated hepatic encephalopathy was 66.7 years old,sensitivity was 0.823,specificity was 0.793;APACHE Ⅱscore predicted 1-year death cut-off value of cirrhosis decompensated hepatic encephalopathy was 24.5 points,sensitivity was 0.807,specificity was 0.756;Child-Pugh classification predicted 1-year death cut-off value of hepatic encephalopathy in decompensated cirrhosis stage C grade,sensitivity was 0.782,specificity was 0.824;blood ammonia predicted 1-year death cut off value of hepatic encephalopathy in de-compensated cirrhosis was 75.3 µmol/L,the sensitivity was 0.855,and the specificity was 0.863.Conclusion Age,APACHE Ⅱ score,Child-Pugh grade and blood ammonia are independent risk factors for secondary hepatic encephalopathy in decompensated liver cirrhosis,and are relat-ed to the prognosis of patients.Age≥66.7 years,APACHE Ⅱ score≥24.5 points,Child-Pugh grade C and blood ammonia ≥75.3 μmol/L indicate poor prognosis.
维普
万方数据