Study on risk factors for hepatic encephalopathy in liver cirrhosis and predictive value of blood ammonia and cholinesterase
Objective To analyze the risk factors for hepatic encephalopathy(HE)in patients with liver cirrhosis,explore the predictive value of blood ammonia and cholinesterase for HE,and develop corresponding preventive strategies to improve patient prognosis.Methods A retrospective analysis was conducted on 772 patients with liver cirrhosis admitted to our hospital from August 2019 to August 2023.Based on the occur-rence of HE,the patients were divided into the HE group(85 patients)and the non-HE group(687 patients).The clinical baseline data of the two groups were collected,and univariate and multivariate analyses were per-formed to screen for relevant risk factors for HE in patients with liver cirrhosis.Changes in blood ammonia and cholinesterase levels were analyzed in patients with liver cirrhosis and HE at different stages.Receiver op-erating characteristic curves were plotted to analyze the predictive value of blood ammonia,cholinesterase,and their combined detection for HE in patients with liver cirrhosis.Results The results of univariate and multi-variate logistic regression model analysis showed that a history of HE,transjugular intrahepatic portosystemic shunt(TIPS),alkalosis,high total bilirubin(TBiL)level,low serum albumin(Alb)level,high Model for End-Stage Liver Disease(MELD)score,low blood sodium level,and high-protein diet were independent risk factors for HE in patients with liver cirrhosis(odds ratios=1.070,1.067,1.087,1.096,1.129,1.133,1.075,1.089,respectively;P＜0.05).Compared with the non-HE group,patients in the HE group had higher blood ammonia levels and lower cholinesterase levels.Blood ammonia levels gradually increased,while cholinesterase levels gradually decreased in patients with HE at stages Ⅰ to Ⅳ.The area under the curve for combined detec-tion was higher than that for blood ammonia and cholinesterase alone,with statistically significant differences(P＜0.05).Conclusion A history of HE,TIPS,alkalosis,high MELD score,high serum TBiL level,low ser-um Alb level,low blood sodium level,and high-protein diet are independent risk factors for HE in patients with liver cirrhosis.Blood ammonia levels are positively correlated with HE staging,while cholinesterase lev-els are negatively correlated with HE staging.Combined detection of blood ammonia and cholinesterase has high clinical value for early diagnosis of HE in patients with liver cirrhosis.
Liver cirrhosisHepatic encephalopathyRisk factorsBlood ammoniaCholines-terasePredictive value
万方数据
维普
