【作者】 牛丹；

【导师】 甘建和；

【作者基本信息】 苏州大学 ， 内科学， 2011， 硕士

【摘要】 背景肝衰竭是由多种因素引起的肝细胞大块、亚大块坏死或严重损害,导致其合成、解毒、排泄和生物转化等肝脏功能发生严重障碍或失代偿,出现以黄疸、凝血功能障碍、肝性脑病和腹水等为主要表现的一种临床严重症候群。该病发展迅速,病情凶险,并发症多,病死率高,但潜在可逆转。因此准确判断肝衰竭的预后对实施有效治疗至关重要。目前肝衰竭的治疗缺乏特殊有效的药物和手段。原则上强调早期诊断、早期治疗,针对不同病因采取相应治疗措施,并积极防治各种并发症。对于糖皮质激素在肝衰竭治疗中的应用目前尚存在不同意见。多数学者认为在肝衰竭早期,若病情发展迅速且无严重感染、出血等并发症者,可酌情使用。人工肝支持系统是治疗肝衰竭有效的方法之一,宜用在肝衰竭早、中期;晚期因其并发症多,需慎重。目的探讨影响肝衰竭患者预后的独立危险因素;评价激素治疗及人工肝治疗对各期肝衰竭预后的影响。方法回顾性分析200例资料完整的肝衰竭病例,收集其临床资料,运用统计学方法,分析不同病因及不同类型肝衰竭患者的预后;筛选出对HBV相关慢加急性(亚急性)肝衰竭预后有影响的独立危险因素;对比Child-Turcotte-Pugh评分系统、MELD评分系统及MELD-Na评分系统对预测肝衰竭预后的价值;评价激素治疗及人工肝治疗对各期肝衰竭预后的影响。结果1.HBV引起的肝衰竭组生存率为43.17%,其他原因引起的肝衰竭组生存率为70.59%,两组之间生存率比较存在统计学差异(P<0.05);慢加急性(亚急性)肝衰竭生存率为54.71%,其他类型肝衰竭生存率为36.59%,两组之间生存率比较存在统计学差异(P<0.05)。2.经Logistic回归筛选影响HBV相关慢加急性(亚急性)肝衰竭预后的独立危险因素为:年龄≥50y、胆酶分离、肝硬化基础、并发症(尤其是肝性脑病、感染、原发性腹膜炎)、CTP评分、MELD-Na评分、TBIL、PTA、Na+及TC。3.激素治疗组与非激素治疗组比较,在HBV相关慢加急性(亚急性)肝衰竭早期,两组生存率比较有统计学差异,前者生存率高于后者(P<0.05);在HBV相关慢加急性(亚急性)肝衰竭中期,两组生存率比较无统计学差异(P>0.05);两组病程在肝衰竭早期及中期比较均有统计学差异(P>0.05),前者病程明显比后者缩短。人工肝治疗组与非人工肝治疗组比较,在HBV相关慢加急性(亚急性)肝衰竭早期及中期,两组生存率比较有统计学差异(P<0.05);在肝衰竭晚期,两组生存率比较无统计学差异(P>0.05)。结论年龄≥50y、胆酶分离、肝硬化基础、并发症(尤其是肝性脑病、感染、原发性腹膜炎)、CTP评分、MELD-Na评分、TBIL、PTA、Na+及TC是影响HBV慢加急性(亚急性)肝衰竭患者预后的独立危险因素。激素治疗可以提高早期HBV相关慢加急性(亚急性)肝衰竭患者生存率并缩短病程;人工肝治疗可以提高早期及中期HBV相关慢加急性(亚急性)肝衰竭患者生存率。更多还原

【Abstract】 Background:Liver failure is caused by many factors of liver cells large, sub-massive necrosis or severe damage, leading to its synthesis, detoxification, excretion and biotransformation of serious disorders such as liver function or decompensation, appear to jaundice, coagulopathy, hepatic encephalopathy and ascites as the main manifestations of a clinically significant syndrome. The disease develops rapidly, the disease risks of complications and high mortality, but the potential can be reversed. Therefore accurately determine the prognosis of liver failure in the implementation of effective treatment is essential. In the current, medical treatment of liver failure lack of effects of drugs and instruments. In principle, we emphasize that early diagnosis and early treatment for different causes of comprehensive treatment to take corresponding measures, and to prevent and treat complications. For glucocorticoids in the treatment of liver failure is currently surviving in the different views. Most scholars believe that early stage of liver failure, if the rapid progression of the disease without serious infection, bleeding and other complications, may be appropriate to use. Artificial liver support system is an effective treatment of liver failure in one of the methods, its application in liver failure early and mid-term is appropriate; advanced liver failure patients can be treated, but more common complications.Objective: To investigate the prognosis of liver failure were independent risk factors; evaluation of hormone therapy and the artificial liver treatment of liver failure on the prognosis.Methods: Retrospective analysis of 200 cases of liver failure cases with complete data, collected clinical data, using statistical methods to analyze the different causes and different types of the prognosis of patients with liver failure; screened for HBV-related acute on chronic (sub-acute) prognosis of liver failure independent risk factors affecting; contrast Child-Turcotte-Pugh scoring system, MELD scoring system, and MELD-Na score system for predicting the prognostic value of liver failure; evaluation of hormone therapy and the artificial liver treatment of liver failure on the prognosis.Results:1. HBV induced liver failure group survival rate was 43.17%, other causes of liver failure, survival rate was 70.59%, there is significant difference in survival between the two groups (P<0.05); acute on chronic (sub-acute) liver failure survival rate was 54.71%, other types of liver failure, survival rate was 36.59%, there is significant difference in survival between the two groups (P<0.05).2. Logistic regression selected by the impact of HBV-related acute on chronic (sub-acute) liver failure were independent risk factors: age≥50y, separation of bile enzymes, liver cirrhosis, complications (especially hepatic encephalopathy, infection, primary peritonitis), CTP score, MELD-Na score, TBIL, PTA, Na+ and TC.3. Hormone therapy group compared with non-hormone therapy in HBV-related acute on chronic (sub-acute) of early liver failure, two groups were significantly different survival rate, survival rate of the former than the latter (P<0.05); in HBV-related slow plus acute (sub-acute) liver failure mid no significant difference in survival the two groups (P> 0.05); two of liver failure in the course of the disease early and mid-term were statistically significant (P>0.05), the former`s course is shorter than the latter. Artificial liver in treatment group compared with non-artificial liver treatment in HBV-related acute on chronic (sub-acute) liver failure early and mid-term, the two groups were significantly different survival (P<0.05); in the late liver failure, two groups of survival There was no significant difference (P>0.05).Conclusion: Age≥50y, separation of bile enzymes, liver cirrhosis, complications (especially hepatic encephalopathy, infection, primary peritonitis), CTP score, MELD-Na score, TBIL, PTA, Na+ and TC is the impact of HBV slow plus acute (sub-acute) prognosis of patients with liver failure were independent risk factors. Hormone therapy may improve early HBV-related acute on chronic (sub-acute) the survival rate of patients with liver failure and shorten the course of the disease; artificial liver treatment can improve the early and mid-term HBV-related acute on chronic (sub-acute) the survival rate of patients with liver failure.更多还原