肝硬化并发肝肾综合征患者预后影响因素分析

肝脏 ›› 2021, Vol. 26 ›› Issue (2): 151-154.

肝硬化并发肝肾综合征患者预后影响因素分析

郝莎莎, 姚佳, 原丽莉

030000 太原山西医科大学附属白求恩医院消化内科

收稿日期:2020-03-24 出版日期:2021-02-28 发布日期:2021-03-28
通讯作者: 原丽莉,Email:dangyuan831@sina.com
基金资助:
国家自然科学基金青年基金项目(81700562);山西省136兴医工程项目(2019xy008);山西省优秀青年基金项目(201801D211009)

Analysis of prognostic factors for hepatorenal syndrome in patients with liver cirrhosis

HAO Sha-sha, YAO Jia, YUAN Li-li

Department of Gastroenterology,Bethune Hospital Affiliated to Shanxi Medical University, Taiyuan 030000,China

Received:2020-03-24 Online:2021-02-28 Published:2021-03-28
Contact: YUAN Li-li,Email:dangyuan831@sina.com

摘要/Abstract

摘要： 目的探讨肝硬化基础上并发肝肾综合征(HRS)患者的预后影响因素。方法选取2019年1月至2019年12月山西医科大学附属白求恩医院收治的97例HRS患者,分为存活组与死亡组,采用多因素logistic回归分析影响患者住院28 d预后的因素。结果住院期间HRS生存24例,死亡73例。死亡组的丙氨酸氨基转移酶、血清总胆红素、总胆汁酸、MELD评分分别为56.00(31.60,114.00)U/L、141.51(51.20,328.93)μmol/L、67.21(28.40,133.76)μmol/L、27.00(20.00,34.00),与存活组的38.00(21.00,56.00)IU/L、45.30(20.11,75.00)μmol/L、27.86(17.26,42.10)μmol/L、18.00(15.50,24.50)比较,差异均有统计学意义(均P<0.05)。经多元logistic回归得出感染(OR=5.291,P=0.048)、MELD评分(OR=1.105,P=0.017)、肝性脑病(OR=0.066,P=0.000)是影响预后的独立因素,进一步ROC曲线分析当MELD评分超过26.50时,HRS死亡风险明显增加(P=0.001)。结论 HRS分型、感染、肝性脑病与HRS预后相关,控制感染、改善肝肾功能及预防肝性脑病起着至关重要的作用。

关键词: 肝硬化, 肝肾综合征, 影响因素, 预后

Abstract: Objective To investigate the prognostic factors for hepatorenal syndrome (HRS) in patients with cirrhosis.Methods Ninety-seventy HRS patients admitted to our hospital from January 2019 to December 2019 were divided into a survival group and a death group. Multivariate logistic regression was used to analyze the factors affecting the 28-day prognosis of patients. Results HRS survival rate during hospitalization was 24.74%. The alanine aminotransferase, serum total bilirubin, total bile acid, and the model of end-stage liver disease (MELD) score in the death group were 56.00 (31.60, 114.00) IU/L, 141.51 (51.20, 328.93) μmol/L, 67.21 (28.40, 133.76) μmol/L and 27.00 (20.00, 34.00), respectively, significantly different from 38.00 (21.00, 56.00) IU/L, 45.30 (20.11, 75.00) μmol / L, 27.86 (17.26, 42.10) μmol/L and 18.00 (15.50, 24.50) in the survival group (P<0.05). HRS classification, infection, MELD score and hepatic encephalopathy were related to prognosis (P<0.05). Multivariate logistic regression showed that infection (OR=5.291, P=0.048), MELD score (OR=1.105, P=0.017) and hepatic encephalopathy (OR=0.066, P=0.000) were independent factors affecting prognosis. Furthermore, the receiver operating characteristic curve of MELD score for predicting death showed that the cut-off value of MELD score was 26.50 (P=0.001).Conclusion By analyzing the data of 97 patients, many common clinical indicators are related to the prognosis of HRS. Controlling infection, improving liver and kidney function and preventing hepatic encephalopathy play the crucial roles in improving the prognosis of HRS.

Key words: Cirrhosis, Hepatorenal syndrome, Influencing factors, Prognosis

郝莎莎, 姚佳, 原丽莉. 肝硬化并发肝肾综合征患者预后影响因素分析[J]. 肝脏, 2021, 26(2): 151-154.

HAO Sha-sha, YAO Jia, YUAN Li-li. Analysis of prognostic factors for hepatorenal syndrome in patients with liver cirrhosis[J]. Chinese Hepatolgy, 2021, 26(2): 151-154.

参考文献

[1] Jan H,Christoph B,Berssenbrügge C,et al.Hepatorenal syndrome: outcome of response to therapy and predictors of survival.Gastroenterol Res Pract,2015,2015:1-8.
[2] Wong F.Recent advances in our understanding of hepatorenal syndrome.Nat Rev Gastroenterol Hepatol,2012,9:382-391.
[3] Modi RM,Patel N,Metwally SN,et al.Outcomes of liver transplantation in patients with hepatorenal syndrome.World J Hepatol,2016,8:999-1011.
[4] Angeli P,Ginès P,Wong F,et al.Corrigendum to diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the international club of ascites.J Hepatol,2015,62:968-974.
[5] Kok B,Abraldes JG. Child-Pugh classification: time to abandon? Semin Liver Dis,2019,39:96-103.
[6] Hadjihambi A,Arias N,Sheikh M,et al.Hepatic encephalopathy: a critical current review.Hepatol Int,2018,12:135-147.
[7] Enescu A,Petrescu F,Mitru? P,et al.Hepatorenal syndrome: diagnosis and treatment - newsreel.Rom J Intern Med,2016,54:143-150.
[8] 中华医学会肝病学分会.肝硬化腹水及相关并发症的诊疗指南.实用肝脏病杂志,2018,21:21-31.
[9] Bhuvanakrishna T,Blake GM,Hilton R,et al.Comparison of estimated GFR and measured GFR in prospective living kidney donors.Int Urol Nephrol,2015,47:201-208.
[10] 陈盛鹏,何卫平,胡瑾华,等.肝肾综合征329例预后分析.传染病信息,2010,23:87-89.
[11] Fagundes C, Ginès P. Hepatorenal syndrome: a severe, but treatable, cause of kidney failure in cirrhosis.Am J Kidney Dis,2012,59:0-0.
[12] Angeli P,Guarda S,Fasolato S,et al.Switch therapy with ciprofloxacin vs. intravenous ceftazidime in the treatment of spontaneous bacterial peritonitis in patients with cirrhosis: similar efficacy at lower cost.Aliment Pharmacol Ther,2010,23:75-84.
[13] Fernández J,Navasa M,Planas R,et al.Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis.Gastroenterology,2007,133:818-824.
[14] Singal AK,Kamath PS.Model for end-stage liver disease.Clin Exp Hepatol,2013,3:50-60.
[15] Schepke M, Appenrodt B, Jörg Heller, et al. Prognostic factors for patients with cirrhosis and kidney dysfunction in the era of MELD: results of a prospective study. Liver Int, 2006, 26:834-839.
[16] 陆伦根. 肝性脑病:离我们并不遥远.中华消化杂志, 2017,37:508-512.
[17] Aldridge DR,Tranah EJ,Shawcross DL.Pathogenesis of hepatic encephalopathy: role of ammonia and systemic inflammation. J Clin Exp Hepatol, 2015,5:S7-S20.
[18] Møller S, Henriksen JH, Bendtsen F. Extrahepatic complications to cirrhosis and portal hypertension: Haemodynamic and homeostatic aspects.World J Gastroentero,2014,20:15499-15517.
[19] Yan Y,Mai L,Zhang Y,et al.Prognostic analysis and establishment of a prognostic model for patients with liver failure with hepatorenal syndrome.Chin J Exp Clin Virol,2012,26:127-129.