【摘要】 探讨影响重型肝炎患者预后的危险因素 ;拟建立一个判断其预后的多因素评分系统 ,为临床治疗决策、合理利用医疗资源提供参考意见。研究了 170例重型肝炎患者 (存活组 4 5例 ,死亡组 12 5例 )的 2 0个临床指标 ,应用SPSS统计软件首先做单因素分析 ;将单因素分析后P <0 0 5的指标进行Logistic回归分析 ;以回归分析后P <0 0 5的指标为参数 ,通过Logistic回归建立一个判断重型肝炎患者预后的多因素评分系统。单因素分析发现 ,代谢性酸中毒、血清 [Na+ ]、凝血酶原活动度、胆红素、临床分型、肝性脑病、消化道出血、血清尿素氮、自发性腹膜炎等 9个指标与重型肝炎的预后有关 (P <0 0 5～ 0 0 0 1) ;Logistic回归分析 ,血清 [Na+ ]、凝血酶原活动度、临床分型、肝性脑病是判断重型肝炎患者预后的独立危险因素 ,并以该 4项指标建立评分系统。总分≥ 5为判断患者死亡的临界值。应用该评分系统回顾性判断 170例重型肝炎患者的预后 :符合率为 80 %。此评分系统对于早期判断、评估重型肝炎患者的预后 ,积极的预防、治疗其危险因素 ,合理利用医疗资源具有重要意义。更多还原

【Abstract】 To analyse mutiple risk factors of predictive survive of severe types virous hepatitis, and to make a scored system which could be determined patient’s prognosis. One hundred seventy patients at the end of hospitalization were divided into alive group (n=45) and dead group (n=125). 133 patients were men, and 37 patients were women. The average age was 43 5 years old (range from 8 to 78). Twenty clinical and laboratory parameters were investigated as predictive risk factors. Univariate analysis was first made. Variables reaching statistical significance( P <0 05)were subsequently introduced in logistic regression to identify the independent risk factors for patient’s survive. The methods of statistical analysis were performed with SPSS 6 0 for WINDOWS statistical package. Nine clinical and laboratory parameters, PTA, serum , hepatic encephalopathy, clinical types of serious virous hepatitis, GI bleeding, hepatic kinedy sydrome, total bilirubin serum BUN, and ascites were closely related to prognosis of severe type of virous hepatitis by analysis of univariate. Four independent risk factors, PTA, serum , hepatic encephalopathy, and clinical types of serious virous hepatitis were obtained by Logistic regression. A scored system was made accroding to those 4 parameters. The threshold score of death was 5. The coincidence rate was 80% by retrospective study of 170 patients with serious virous hepatitis. PTA, serium , hepatic encephalopathy, and clinical types of serious virous hepatitis are independent predictive factors in patients with serious virous hepatitis. It is important that the risk factors should be early assessed, ward off, and treated. The treatment strategy can be determined and the medical resources can be reasonably used according to this score system.更多还原