慢加急性肝衰竭前期临床常规预警指标研究 - 第三军医大学学报.docVIP

慢加急性肝衰竭前期临床常规预警指标研究 （400038重庆，第三军医大学西南医院全军感染病研究所） 目的 分析慢加急性肝衰竭前期的临床特征，发掘预警肝衰竭发生的指标，建立基于临床指标的早期肝衰竭预警模型。方法 回顾性分析我科2002年5月至2008年4月慢加急性肝衰竭前期病例50例、慢性乙型肝炎重度病例62例，比较其发病诱因、发病特点以及临床常规辅助检查指标变化特征间差异，并通过Logistic回归建立判断肝衰竭发生风险的模型。结果 两组病例间性别、发病诱因、黄疸出现时间、有无肝硬化、HBeAg阳性率无显著性差异，CHB重度组患者发病年龄分布范围较大（12～72岁），Pre-ACLF组患者发病年龄较集中（29～69岁），两者有显著差异。首次辅助检查指标中，两组凝血检验指标与TBil存在显著差异。指标的变化速率中，Pre-ACLF组PT、INR、TBil最大增加速率显著高于CHB重度组(P=6.386×10-11、1.905×10-11、0.0065)。ACLF发生概率的预警模型为P=1/1+e^-(-2.414+7.687×PT延长速率)，PT最大延长速率每天增加1s，肝衰竭的风险增加2179.045倍。结论 与CHB重度病例比较，Pre-ACLF病例病变相对较剧烈，主要表现为凝血功能的大幅下降与黄疸的大幅增加。其中PT最大延长速率是预测肝衰竭发生最强的风险因素。 肝功能衰竭，慢加急性；肝炎，乙型；临床特征；预警 R512.6 [文献标志码] A Routine early clinical warning indications of prophase acute-on-chronic liver failure Liu Ming, Deng Guohong, Tan Shun, Liu Hongli, Sun Xiaowen, Tan Wenting, Mao Qing (Chinese PLA Institute of Infectious Diseases, Southwest Hospital, Third Military University, Chongqing 400038, China) [Abstract] Objective To establish the clinical indications-based early liver failure warning model by analyzing the clinical characteristics and digging the early warning indications of prophase acute-on-chronic liver failure (ACLF). Methods Fifty patients with prophase acute-on-chronic liver failure (group A) and 62 patients with severe chronic hepatitis B (group B) were retrospectively analyzed. Their predisposing factors, disease onset characteristics, and routine clinical indications were compared. A liver failaure risk model was established by logistic regression analysis. Results No significant difference was found in gender, predisposing factors, jaundice-occuring time, liver cirrhosis, and HBeAg positive rate between the two groups. The disease onset age was 12-72 years in group B and 29-69 years in group A (P0.05). Blood coagulation function test showed that the serum TBil level was significantly different between the two groups. The PT, INR and TBil levels were significantly higher in group A than in group B