摘要
目的 分析肝硬化合并房性心律失常患者的临床特征,探讨肝硬化合并房性心律失常患者院内死亡相关危险因素.方法 纳入2014年1月-2021年12月的252例肝硬化合并房性心律失常住院患者,分析其临床特征.此外,根据上述患者院内死亡情况进行分组,其中院内死亡45例,归为死亡组;生存207例,归为生存组.比较两组患者的临床资料以及实验室资料的差异,分析肝硬化合并房性心律失常患者院内死亡的危险因素.计量资料采用t检验或秩和检验比较,计数资料采用x2检验或Fisher确切概率法比较;采用logistic回归法进行多因素分析.结果 252例患者中男女比例相同(男/女为126/126),年龄26～89(66.77±10.46)岁,汉族占79.4％.房性心律失常类型以心房颤动为主(P＜0.001);肝硬化病因以乙型肝炎为主(56.3％),Child-Pugh分级A/B/C级57/72/123例,Child-Pugh、终末期肝病模型(MELD)评分分别为(10.30±1.77)分、18.0(11.0,29.0)分,院内病死率为17.9％(45/252).所有患者并发症总体发生率为89.28％,并发症及其发生率依次为腹腔积液71.4％、脾功能亢进71.0％、自发性腹膜炎64.7％、食管-胃底静脉曲张64.3％、肝肾综合征32.5％、肝性脑病32.1％、食管-胃底静脉曲张破裂出血26.2％.院内死亡组新发心房颤动发生率为73.3％,远远大于生存组的44.0％(P＜0.05).多因素logistic回归分析显示新发心房颤动(OR=2.707,95％CI:1.119～6.549)、食管-胃底静脉曲张(OR=3.287,95％CI:1.189～9.085)、血 钾(OR=3.820,95％CI:1.532～9.526)、MELD 评 分(OR=1.108,95％CI:1.061～1.157)是肝硬化合并房性心律失常患者院内死亡的独立危险因素.结论 肝硬化合并房性心律失常患者肝功能损害较为严重,且更易发生腹腔积液、脾功能亢进、肝肾综合征等并发症,新发心房颤动、食管-胃底静脉曲张、高血钾水平、高MELD评分为肝硬化合并房性心律失常患者院内死亡的危险因素,应对相应患者加大关注,及时对症处理.
Abstract
Objective To analyze and explore the clinical characteristics and risk factors related to nosocomial mortality in patients with liver cirrhosis combined with atrial arrhythmia.Methods 252 hospitalized patients with liver cirrhosis combined with atrial arrhythmia from January 2014 to December 2021 were enrolled,and their clinical characteristics were analyzed.The above-mentioned patients were divided into groups according to their nosocomial mortality rate.Among them,45 nosocomial mortality cases were classified as the mortality group,and 207 survival cases were classified as the survival group.The differences in clinical data and laboratory data between the two groups were compared.The risk factors for nosocomial mortality in patients with liver cirrhosis combined with atrial arrhythmia were analyzed.The t-test,or rank-sum test,was used to compare measurement data.The chi-square test,or Fisher's exact probability method,was used to compare enumeration data.Multivariate analysis was performed by the logistic regression method.Results Among the 252 cases,the male-to-female ratio was the same(male/female ratio:126/126).The age range was 26 to 89(66.77±10.46)years.Han ethnicity accounted for 79.5％.The main type of atrial arrhythmia was atrial fibrillation(P＜0.001).The main cause of liver cirrhosis was post-hepatitis B cirrhosis(56.3％).There were 57/72/123 cases of CTP grade A/B/C.The CTP and Model for End-Stage Liver Disease(MELD)scores were 10.30±1.77 and 18.0(11.0,29.0),respectively.The nosocomial mortality rate was 17.9％(45/252).The overall incidence rate of complications in all patients was 89.28％,with complications occurring in the following order:71.4％ascites,71.0％hypersplenism,64.7％spontaneous peritonitis,64.3％esophageal gastric varices,32.5％hepatorenal syndrome,32.1％hepatic encephalopathy,and 26.2％esophageal gastric variceal bleeding.The incidence rate of new-onset atrial fibrillation in the nosocomial mortality group was 73.3％,which was much higher than the 44.0％rate in the survival group(P＜0.05).Multivariate logistic regression analysis showed that new-onset atrial fibrillation(OR=2.707,95％CI 1.119～6.549),esophageal-gastric varices(OR=3.287,95％CI 1.189～9.085),serum potassium(OR=3.820,95％CI 1.532～9.526),and MELD score(OR=1.108,95％CI 1.061～1.157)were independent risk factors for nosocomial mortality in patients with liver cirrhosis combined with atrial arrhythmia.Conclusion Patients with cirrhosis combined with atrial arrhythmias have more severe liver function damage and are more likely to develop complications such as ascites,hypersplenism,and hepatorenal syndrome.New-onset atrial fibrillation,esophageal-gastric varices,hyperkalemia,and a high MELD score are risk factors for nosocomial mortality in patients with liver cirrhosis combined with atrial arrhythmia,so more attention should be paid to corresponding patients for timely symptomatic treatment.
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