乙型肝炎肝硬化失代偿期患者合并肝性脊髓病的临床特征分析

肝脏 ›› 2024, Vol. 29 ›› Issue (6): 687-690.

乙型肝炎肝硬化失代偿期患者合并肝性脊髓病的临床特征分析

李菊红, 郝彦琴, 石敏

030001 太原山西医科大学第一临床医学院(李菊红,石敏);山西医科大学第一医院感染病科(郝彦琴)

收稿日期:2023-10-09 出版日期:2024-06-30 发布日期:2024-08-28
通讯作者: 郝彦琴,Email:1107382203@qq.com
基金资助:
山西省自然科学研究面上项目(202103021224241)

Clinical characteristics of hepatitis B patients with decompensated cirrhosis combined with hepatic myelopathy

LI Ju-hong¹, HAO Yan-qin², SHI Min¹

1. Shanxi Medical University First Clinical Medical College, Taiyuan 030001, China;
2. Department of Infectious Diseases, First Hospital of Shanxi Medical University, Taiyuan 030001, China

Received:2023-10-09 Online:2024-06-30 Published:2024-08-28
Contact: HAO Yan-qin,Email:1107382203@qq.com

摘要/Abstract

摘要： 目的分析乙型肝炎肝硬化失代偿期患者合并肝性脊髓病的临床特征。方法选择2018年4月至2023年4月山西医科大学第一医院收治的40例乙型肝炎肝硬化失代偿期合并肝性脊髓病患者作为观察组,选择同期未合并肝性脊髓病患者55例作为对照组。比较两组临床特征,采用多因素logistic回归分析乙型肝炎肝硬化失代偿期患者合并肝性脊髓病的独立危险因素。结果观察组的总胆红素、AST、ALT和血氨水平分别为(40.5±24.8)μmol/L、(220.6±57.8)U/L、(253.5±66.4)U/L、(116.3±23.5)μmol/L,均高于对照组的(32.6±15.4)μmol/L、(120.5±58.2)U/L、(153.1±64.6)U/L、(72.6±13.8)μmol/L;观察组白蛋白、胆碱酯酶、凝血酶原时间活动度分别为(10.3±2.1)g/L、(2.1±0.8)U/L、(27.8±4.2)%,低于对照组的(12.1±2.2)g/L、(2.6±0.2)U/L、(31.6±6.8)%,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,乙型肝炎肝硬化失代偿期患者合并肝性脊髓病的危险因素为ALT、凝血酶原时间活动度、高血氨和低白蛋白(OR=0.382、4.568、4.166、0.401,P<0.05)。结论 ALT、凝血酶原时间活动度、高血氨、低白蛋白为独立危险因素。

关键词: 乙型肝炎, 肝硬化失代偿, 肝性脊髓病, 临床特征

Abstract: Objective To analyze clinical features of hepatitis B patients with decompensated cirrhosis combined with hepatic myelopathy. Methods Between April 2018 and April 2023, 40 hepatitis B patients with decompensated cirrhosis and hepatic myelopathy were enrolled in this study as the observation group. A control group consisting of 55 hepatitis B patients with decompensated cirrhosis but without hepatic myelopathy was also selected from the same period. Clinical characteristics of both groups were compared, and independent risk factors for hepatic myelopathy in patients with decompensated cirrhosis were analyzed using multifactorial logistic regression. Results The levels of total bilirubin, glutathione, glutathione and serum ammonia in the observation group were (40.5±24.8) μmol/L, (220.6±57.8) U/L, (253.5±66.4) U/L, (116.3±23.5) μmol/L, respectively, which were higher than those in the control group [(32.6±15.4) μmol/L, (120.5±58.2) U/L, (153.1±64.6) U/L, (72.6±13.8) μmol/L]. Conversely, albumin, cholinesterase, and prothrombin time activity in the observation group were (10.3±2.1) g/L, (2.1±0.8) U/L, and (27.8±4.2) %, respectively, which were significantly lower than those in the control group [(12.1± (2.2) g/L, (2.6±0.2) U/L, (31.6±6.8) %, respectively, P<0.05]. Multifactorial logistic regression analysis identified alanine aminotransferase, prothrombin time activity, high serum ammonia, and low albumin as independent risk factors for hepatic myelopathy in hepatitis B patients with decompensated cirrhosis (OR=0.382, 4.568, 4.166, 0.401, P<0.05). Conclusion Albumin transaminase, prothrombin time activity, high blood ammonia, and low albumin are independent risk factors for hepatic myelopathy in patients with decompensated cirrhosis due to hepatitis B.

Key words: Hepatitis B, Decompensated cirrhosis, Hepatic myelopathy, Clinical features

李菊红, 郝彦琴, 石敏. 乙型肝炎肝硬化失代偿期患者合并肝性脊髓病的临床特征分析[J]. 肝脏, 2024, 29(6): 687-690.

LI Ju-hong, HAO Yan-qin, SHI Min. Clinical characteristics of hepatitis B patients with decompensated cirrhosis combined with hepatic myelopathy[J]. Chinese Hepatolgy, 2024, 29(6): 687-690.

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参考文献

[1] 杨慧玲, 刘小静, 何英利, 等. 失代偿期乙型肝炎肝硬化患者发生医院感染临床特点及危险因素分析[J]. 实用肝脏病杂志, 2020, 23(1): 78-81.
[2] Llerena Velastegui J, Vera Sanchez M, Villacis Lopez C. Characteristics of spontaneous portosystemic shunts in cirrhotic patients as a predictor of decompensation[J]. Dig Liver Dis, 2022, 54(9): 1285-1286.
[3] 申力军, 马宇茗, 闫丽萍, 等. 179例肝性脊髓病临床特点分析[J]. 传染病信息, 2021, 34(4): 310-315.
[4] 何益信, 李颖霞, 姜利彬, 等. 肝硬化失代偿期合并肝性脊髓病临床特点及相关危险因素分析[J]. 北京医学, 2021, 43(10): 970-979.
[5] 谢高生, 黄樱, 朱海兵. 乙型肝炎后肝硬化并肝性脊髓病1例报告[J]. 临床神经病学杂志, 2020, 33(3): 195-200.
[6] 中华医学会肝病学分会. 肝硬化诊治指南[J]. 中华肝脏病杂志, 2019, 27(11): 846-865.
[7] 周萍, 周伟, 张强. 不同肝功能Child-Pugh分级全身麻醉患者丙泊酚诱导及麻醉效果[J]. 医药导报, 2019, 38(1): 66-70.
[8] Wang Q, Zhao H, Deng Y, et al. Validation of baveno vii criteria for recompensation in entecavir-treated patients with hepatitis b-related decompensated cirrhosis[J]. J Hepatol, 2022, 77(6): 1564-1572.
[9] Yip TC, Wong VW, Lai MS, et al. Risk of hepatic decompensation but not hepatocellular carcinoma decreases over time in patients with hepatitis B surface antigen loss[J]. J Hepatol, 2023, 78(3): 524-533.
[10] Acar S, Dinckan A, Akyildiz M. Liver transplantation in hepatic myelopathy[J]. Hepatol Forum, 2022, 3(2): 64-65.
[11] Zhu Z, Liu Y, Wu W, et al. Liver transplantation reverses hepatic myelopathy in hepatitis b-related decompensated liver cirrhosis: case report and review of the literature[J]. Transplant Proc, 2022, 54(1): 158-160.
[12] Liu K, Chen G, Ren SY, et al. Regional gray matter abnormality in hepatic myelopathy patients after transjugular intrahepatic portosystemic shunt: a voxel-based morphometry study[J]. Neural Regen Res, 2019, 14(5): 850-857.
[13] Ciarlariello VB, Fujino MVT, Almeida MD, et al. Teaching video neuroimages: hepatic myelopathy: an unusual neurologic complication of hepatic encephalopathy[J]. Neurology, 2019, 93(3): 320-321.
[14] Lee HA, Jung JY, Lee YS, et al. Direct bilirubin is more valuable than total bilirubin for predicting prognosis in patients with liver cirrhosis[J]. Gut Liver, 2021, 15(4): 599-605.
[15] Zhang Z, Shang J, Yang Q, et al. Exosomes derived from human adipose mesenchymal stem cells ameliorate hepatic fibrosis by inhibiting pi3k/akt/mtor pathway and remodeling choline metabolism[J]. J Nanobiotechnology, 2023, 21(1): 29.
[16] Boron M, Hauzer-Martin T, Keil J, et al. Circulating thrombomodulin: release mechanisms, measurements, and levels in diseases and medical procedures[J]. TH Open, 2022, 6(3) :194-212.