【摘要】 目的分析影响乙型肝炎相关慢加急性肝衰竭(ACLF)患者发生肝肾综合征(HRS)的高危因素,以期建立一种筛查、预测发生HRS的高危因素的方法。方法收集2010年1月至2018年6月期间在佛山市第一人民医院、江门市中心医院和南方医科大学顺德医院住院治疗的391例乙型肝炎相关ACLF患者的资料,根据是否发生HRS分为HRS组78例和非HRS组313例,比较两组患者临床特征的差异。对相关自变量进行单因素Logistic回归和多因素Logistic回归分析以筛查HRS的独立危险因素。对上述独立危险因素采用分类树模型进一步筛查影响HRS发病的独立危险因素。基于增益指数评估不同结点的发病风险并建立评估HRS发病风险的简易风险评估表。结果 HRS组患者的终末期肝病评分(MELD)和中性粒细胞比例分别为(26.9±8.5)分、(72.8±11.8)%,明显高于非HRS组的(22.1±6.9)分、(68.0±11.3)%,差异均具有统计学意义(P<0.05);HRS组患者上消化道出血的发病率为26.9%(21/78),明显高于非HRS组的5.8%(18/313),差异具有显著统计学意义(P<0.01);多因素Logistic回归分析结果显示,MELD评分、上消化道出血和中性粒细胞比值为ACLF患者发生HRS的独立影响因素(P<0.05);分类树模型法提示,ACLF患者发生HRS的高危情况依次为有肝性脑病和上消化道出血者、无肝性脑病但MELD评分>32.420者、无上消化道出血但有肝性脑病者。结论乙型肝炎相关ACLF患者出现以下3类情况应该高度警惕并及积极预防肝肾综合征的发生:有肝性脑病和上消化道出血;无肝性脑病但MELD评分>32.420;无上消化道出血但有肝性脑病。更多还原

【Abstract】 Objective To analyze the high-risk factors affecting hepatorenal syndrome(HRS) in patients with hepatitis B-related acute-on-chronic liver failure(ACLF), in order to establish a method to screen and predict the risk factors of HRS. Methods The clinical data of 391 patients with hepatitis B-related ACLF hospitalized in Department of Infectious Diseases from three hospitals, including First People’s Hospital of Foshan, Jiangmen Central Hospital, and Shunde Hospital, Southern Medical University, from January 2010 to June 2018 were collected and analyzed. There were 78 patients in HRS group and 313 patients in non-HRS group according to the status of HRS. The current study compared the baseline characteristics of patients in HRS group and non-HRS group. Univariate logistic regression and multivariate logistic regression were used to explore the independent risk factors of HRS. Classification tree model was used to determine the independent risk factors of HRS by using chi-squared automatic interaction detector method. According to gain indexes generated by classification tree model, the current study evaluated the HRS prevalence in different classification tree nodes and constructed a simple risk assessment table to assess the risk of HRS. Results The model for end-stage liver disease(MELD) score and neutrophil ratio were(26.9±8.5) points and(72.8±11.8)% in HRS group,significantly higher than(22.1±6.9) points and(68.0±11.3)% in non-HRS group(P<0.05). The prevalence of upper gastrointestinal bleeding was 26.9%(21/78) in HRS group, significantly higher than 5.8%(18/313) in non-HRS group(P<0.05). Multivariate logistic regression analysis suggested that MELD score(OR=1.108), gastrointestinal bleeding(OR=7.537), and neutrophil percentage(OR=1.075) might be the independent factors of HRS in patients with ACLF. According to the simple risk assessment table generated by classification tree model, the prevalence rates of HRS were arranged from high to low as following: patients with hepatic encephalopathy(HE) and upper gastrointestinal hemorrhage; patients with MELD score>32.420, but without HE; patients with HE, but without upper gastrointestinal hemorrhage.Conclusion Patients with hepatitis B related ACLF should be highly alert to the occurrence of HRS under the following circumstances: patients with HE and upper gastrointestinal hemorrhage; patients with MELD score>32.420, but without HE; patients with HE, but without upper gastrointestinal hemorrhage.更多还原