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目的通过对乙型肝炎相关慢加急性肝功能衰竭患者临床诊疗治疗进行研究分析,总结整理乙型肝炎相关慢加急性肝功能衰竭患者并发自发性腹膜炎的危险因素。方法选取我院2011年1月~2014年10月期间300例乙型肝炎相关慢加急性肝功能衰竭患者作为研究对象,对所有患者的临床诊疗资料进行回顾性分析。包括性别、年龄、糖尿病病史、抗病毒治疗史、家族病史等基本临床资料;上消化道出血、肝性脑病、肺部感染以及肝肾综合征等并发症状;以及谷氨酸转移酶、天冬氨酸基转移酶、γ-谷氨酰转移酶、尿素氮、总胆红素、血糖、肌酐、甘油三酯、总胆固醇、血红蛋白、白细胞计数、血清Na离子浓度、外周血中性粒细胞比值、血小板计数、HBV-DNA、甲胎蛋白、凝血酶原以及红细胞积压等临床检测指标。采用回归分析研究方式对以上各项因素进行单因素回归分析与多因素回归分析,筛选出乙型肝炎相关慢加急性肝功能衰竭患者并发自发性腹膜炎的危险因素。结果经过多因素Logistic回归分析,得到如下结果:年龄(回归系数为0.042;比值为1.029;95%可信区间为1.01~1.12),外周血中性粒细胞比值(回归系数为0.034;比值为1.004;95%可信区间为1.12~1.56),上消化道出血(回归系数为-0.087;比值为1.016;95%可信区间为0.87~1.03),肺部感染(回归系数为-0.621;比值为0.535;95%可信区间为0.38~0.79)是影响乙型肝炎相关慢加急性肝功能衰竭患者并发自发性腹膜炎的独立危险因素。结论乙型肝炎相关慢加急性肝功能衰竭患者并发自发性腹膜炎临床诊断过程中,患者的年龄、上消化道出血状况、外周血中性粒细胞比、肺部感染等为并发性腹膜炎的危险因素,需要重点注意,以提高临床诊疗效果。
Objective To analyze and analyze the clinical diagnosis and treatment of patients with chronic hepatitis B and acute liver failure, and summarize the risk factors of spontaneous peritonitis in patients with chronic hepatitis B and acute liver failure. Methods From January 2011 to October 2014 in our hospital, 300 cases of hepatitis B-associated chronic liver failure patients with acute liver failure were selected as the research object, and the clinical diagnosis and treatment data of all patients were retrospectively analyzed. Including gender, age, history of diabetes, history of antiviral therapy, family history and other basic clinical data; upper gastrointestinal bleeding, hepatic encephalopathy, pulmonary infection and hepatorenal syndrome and other complications; and glutamate transferase, aspartate Glutamyltransferase, urea nitrogen, total bilirubin, blood glucose, creatinine, triglyceride, total cholesterol, hemoglobin, white blood cell count, serum Na ion concentration, peripheral blood neutrophil ratio , Platelet count, HBV-DNA, alpha-fetoprotein, prothrombin, and red blood cell backlog and other clinical indicators. Regression analysis was used to analyze the above factors by one-way regression analysis and multivariate regression analysis. The risk factors of spontaneous peritonitis in patients with chronic hepatitis B and acute liver failure were screened out. Results After multivariate logistic regression analysis, the following results were obtained: age (regression coefficient 0.042; odds ratio 1.029; 95% confidence interval 1.01 to 1.12), peripheral blood neutrophil ratio (regression coefficient 0.034; ratio 1.004 ; 95% confidence interval 1.12-1.56), upper gastrointestinal bleeding (regression coefficient -0.087; ratio 1.06; 95% confidence interval 0.87-1.03), pulmonary infection (regression coefficient -0.621; ratio 0.535; 95% confidence interval 0.38 ~ 0.79) is an independent risk factor for spontaneous peritonitis in patients with chronic hepatitis B and acute liver failure. Conclusions During the clinical diagnosis of spontaneous peritonitis in patients with chronic hepatitis B and acute liver failure, the patients’ age, upper gastrointestinal bleeding, peripheral blood neutrophil ratio and pulmonary infection are the risk factors of complicated peritonitis , Need to pay attention to improve the clinical diagnosis and treatment effect.