论文部分内容阅读
目的对影响重型肝炎预后的单因素进行分析,从中筛选出对预后有明显影响的因素,并确定其与预后的相关程度,从而构建出重型肝炎预后评估系统,并检验其效能。方法将重庆医科大学附属第二医院感染病科1997年1月至2003年3月收治的301例重型肝炎患者分为治疗有效组和治疗无效组,分别从年龄,性别、临床分型、病原分型、并发症,既往病史、生化指标等方面进行回顾性研究,借助SPSS 软件进行Logistic回归分析,确定这些因素与重型肝炎预后的相关程度。利用得到的独立危险因素和各自的相关系数构建重型肝炎预后评分公式,将原始数据代人公式进行评分,验证系统的评估效能。结果年龄、临床分型、肝性脑病、电解质紊乱、原发性腹膜炎、酸碱失衡、肝肾综合征、消化道出血、既往肝硬化基础、酶胆分离、凝血酶原活动度、总胆红素、尿素氮、肌酐、血钠等指标与预后有明显的关系。进一步的Logistic回归分析提示:凝血酶原活动度、尿素氮、血钠、肝性脑病为影响预后的独立的危险因素。对构建的评估系统的评价效能进行研究发现:治疗有效组和治疗无效组评分差异有统计学意义(P<0.01);低于40 分组,治疗有效率为76.9%,40～80分组,治疗有效率仅12.5%;80分以上组,治疗均无效,两组评分差异亦有统计学意义。结论凝血酶原活动度、尿素氮、血钠、肝性脑病作为独立的危险因素可用于预后评分系统的构建。本研究构建的重型肝炎预后评估系统能较好地反映预后。
Objective To analyze the single factor influencing the prognosis of severe hepatitis and select the factors that have a significant effect on the prognosis and determine its correlation with the prognosis so as to construct a prognostic evaluation system for severe hepatitis and test its efficacy. Methods One hundred and thirty-one patients with severe hepatitis admitted from January 1997 to March 2003 in Department of Infectious Diseases, Second Affiliated Hospital of Chongqing Medical University were divided into two groups: treatment-effective group and treatment-ineffective group. The patients were divided into three groups according to their age, gender, clinical type, Type, complications, past medical history, biochemical indicators and other aspects of retrospective study, with SPSS software Logistic regression analysis to determine the correlation between these factors and the prognosis of severe hepatitis. The independent risk factors and their correlation coefficients were used to construct the prognostic score formula of severe hepatitis, and the original data were scored on behalf of the formula to verify the evaluation performance of the system. Results Age, clinical classification, hepatic encephalopathy, electrolyte disturbances, primary peritonitis, acid-base imbalance, hepatorenal syndrome, gastrointestinal bleeding, previous cirrhosis, enzyme-biliary separation, prothrombin activity, Su, urea nitrogen, creatinine, serum sodium and other indicators have a clear relationship with the prognosis. Further Logistic regression analysis showed that prothrombin activity, urea nitrogen, serum sodium and hepatic encephalopathy were independent risk factors for prognosis. The evaluation of the constructed evaluation system showed that there was significant difference between the effective treatment group and the ineffective treatment group (P <0.01), while the effective treatment rates were 76.9% and 40-80 in the group of less than 40, Efficiency of only 12.5%; 80 points above the group, the treatment was ineffective, the two groups also had significant differences in the score. Conclusion Prothrombin activity, urea nitrogen, serum sodium and hepatic encephalopathy can be used as prognostic scoring system as independent risk factors. The construction of this study of severe hepatitis prognosis evaluation system can better reflect the prognosis.