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目的对影响肝性脊髓病(HM)患者预后的因素进行分析,探讨影响预后的危险因素。方法回顾性分析91例HM患者的临床资料,观察12例好转者和79例恶化者的临床资料,包括:年龄,性别,肝病病程,Child-Pugh分级,饮酒史,有无门体静脉分流手术、脾切除术史,肝硬化并发症(腹水、胸水、上消化道出血、腹膜炎、肝性脑病、肝肾综合征),合并症(糖尿病、高血压病),实验室指标(TBil、Alb、ALT、AST、CHE、WBC、PLT、PTA、BLA)等,并进行单因素分析,进一步行Logistic回归分析。结果单因素分析结果提示,PTA、CHE、Child-Pugh分级两组比较差异有统计学意义(P<0.05),与好转组比较,恶化组具有更低的PTA值和CHE值以及更高的Child-Pugh分级(P<0.05)。将单因素分析中有意义变量经Logistic回归分析结果提示,CHE、Child-Pugh分级影响HM患者的预后(P<0.05),Child-Pugh分级越高,预后越差(OR=32.825);CHE值越小,预后越差(OR=0.243)。结论 CHE、Child-Pugh分级是HM预后的独立危险因素,CHE越低、Child-Pugh分级越高,HM患者预后越差。
Objective To analyze the prognostic factors in patients with hepatic myelopathy (HM) and explore the risk factors that affect prognosis. Methods The clinical data of 91 patients with HM were retrospectively analyzed. The clinical data of 12 patients with improvement and 79 patients with deterioration were retrospectively analyzed. The clinical data including age, sex, duration of liver disease, Child-Pugh grading, alcohol drinking history, and portal vein shunt (Spleen, pleural effusion, upper gastrointestinal bleeding, peritonitis, hepatic encephalopathy, hepatorenal syndrome), comorbidities (diabetes, hypertension) ALT, AST, CHE, WBC, PLT, PTA, BLA), etc., and univariate analysis, further Logistic regression analysis. Results The results of univariate analysis showed that there was significant difference between the PTA, CHE and Child-Pugh groups (P <0.05), and the worsened group had lower PTA and CHE values and higher Child -Pugh classification (P <0.05). Logistic regression analysis of significant variables in univariate analysis suggested that the CHE and Child-Pugh grading influenced the prognosis of patients with HM (P <0.05), the higher the Child-Pugh classification, the worse the prognosis (OR = 32.825); the CHE value The smaller the worse the prognosis (OR = 0.243). Conclusion CHE and Child-Pugh classification are independent risk factors for HM prognosis. The lower the CHE, the higher the Child-Pugh classification, the worse the prognosis of HM patients.