论文部分内容阅读
目的分析 HBeAg 阴性乙型肝炎肝硬化患者死亡影响因素。方法前瞻性地观察166例 HBeAg阴性乙型肝炎肝硬化患者及51例 HBeAg 阳性乙型肝炎肝硬化患者的死亡情况,同时对 HBeAg 阴性乙型肝炎肝硬化患者的性别、年龄、丙氨酸氨基转移酶(ALT)活动形式、HBV DNA 定量、终末期肝病模型(MELD)评分、Child-Pugh 分级与死亡的关系进行多因素 Logistic 回归分析。结果单因素分析显示:在 HBeAg 阴性乙型肝炎肝硬化组,男性病死率高于女性(P=0.042);死亡组平均年龄高于存活组(P=0.011);MELD 评分≥18分组病死率(30.95%)高于 MELD 评分<18分组(P=0.007);Child C 组病死率(46.34%)>ChildB 组(19.75%)>Child A 组(P<0.01)。在 HBeAg 阳性乙型肝炎肝硬化组,MELD 评分≥18分组病死率高于 MELD<18分组(P=0.04)。Child A 患者组其病死率明显低于 Child C 患者组(P=0.021)。多因素分析显示:高龄、高 Child-Pugh 分级、ALT 持续升高是 HBeAg 阴性乙型肝炎肝硬化患者死亡的独立危险因素(P<0.05)。结论在 HBeAg 阴性乙型肝炎肝硬化患者中,高龄为死亡的独立危险因素;男性可能比女性死亡危险大;Child-Pugh 分级越低,预后越好,相对于 Child A 及 B,Child C 为死亡的独立危险因素;具有更高的MELD 评分的患者其死亡危险性高于低 MELD 评分患者;相对于 ALT 长期正常患者,ALT 持续升高为死亡的独立危险因素。
Objective To analyze the influencing factors of death in cirrhotic patients with HBeAg-negative hepatitis B Methods A total of 166 patients with HBeAg-negative hepatitis B cirrhosis and 51 patients with HBeAg-positive hepatitis B cirrhosis were prospectively observed. At the same time, sex, age, alanine aminotransferase (ALT) activity, HBV DNA quantification, end-stage liver disease (MELD) score, Child-Pugh classification and death were analyzed by multivariate Logistic regression. Results The univariate analysis showed that in HBeAg-negative cirrhotic patients, the male mortality rate was higher than that in female patients (P = 0.042). The mean age of death patients was higher than that of survivors (P = 0.011). The mortality of MELD patients ≥18 30.95%) were higher than those in MELD score <18 group (P = 0.007); Child C group (46.34%)> ChildB group (19.75%)> Child A group (P <0.01). In the HBeAg-positive cirrhosis group, the MELD score ≥18 was associated with a higher mortality than MELD <18 (P = 0.04). The mortality of Child A patients was significantly lower than that of Child C patients (P = 0.021). Multivariate analysis showed that the higher age and higher Child-Pugh classification and the persistently elevated ALT were the independent risk factors of death in patients with HBeAg-negative cirrhosis (P <0.05). CONCLUSION: Among the patients with HBeAg-negative hepatitis B cirrhosis, senile age is an independent risk factor for death; males may be more likely to die than females; the lower the Child-Pugh classification, the better the prognosis; Child C is death relative to Child A and B . The risk of death in patients with higher MELD score was higher than that in patients with low MELD score. ALT continued to rise as an independent risk factor for death relative to long-term ALT patients.