失代偿期肝硬化急性肾功能异常相关危险因素分析

发布时间：2018-02-27 20:54

本文关键词： 肝硬化失代偿期急性肾功能异常腹水单因素分析 Logistic回归分析　出处：《安徽医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨失代偿期肝硬化患者发生急性肾功能异常的危险因素，为临床防治该并发症提供参考依据。方法收集254例肝硬化伴有腹水患者的相关临床资料,将2周内血肌酐上升超过正常值高限,或者2周内血肌酐上升超过基线值2倍以上（大于226μmol/L）的患者，作为观察组，将血肌酐在正常范围的患者作为对照组，回顾性分析入选病例基础临床资料及相关实验室指标与急性肾功能异常的关系。临床基础资料包括：性别、年龄、肝硬化病因、肝硬化病程、以及转归；相关并发症包括：肝性脑病（HE）、上消化道出血、自发性腹膜炎（SBP）以及其他部位感染；实验室指标包括：白蛋白(ALB)、总胆红素(TBIL)、血钠水平、血浆凝血酶原活动度（PTA）、白细胞计数(WBC)、血小板计数（PLT）、以及血肌酐。对入选指标：性别、年龄、肝硬化病程、肝性脑病、上消化道出血、自发性腹膜炎、其他部位感染、白蛋白、总胆红素、血钠水平、血浆凝血酶原活动度、白细胞计数、血小板计数进行单因素分析，其中计量资料符合正态分布的采用t检验，其中包括年龄、肝硬化病程、白蛋白、血浆凝血酶原活动度，不符合正态分布的采用Z检验包括：总胆红素、血钠水平、白细胞计数以及血小板计数；计数资料采用χ2检验，包括：性别、肝性脑病、上消化道出血、自发性腹膜炎、其他部位感染。在使用单因素分析之后，，对单因素分析有统计学意义（p＜0.05）的指标采用Logistic回归分析，观察肝硬化腹水患者发生急性肾功能异常的独立危险因素。结果：单因素分析结果提示性别、年龄、肝硬化病程、白蛋白、上消化道出血，观察组与对照组比较无统计学意义（p〉0.05）。肝性脑病发生率观察组占50.4%，对照组10.1%；两组之间比较有统计学意义（p＜0.01），自发性腹膜炎发生率观察组70.4%，对照组41.2%，两组之间比较有统计学意义（p＜0.01）；其他部位感染发生率观察组32.6%，对照组19.3%，两组之间比较有统计学意义（p＜0.05）；血钠水平观察组中位数128mmol/l，对照组中位数136.8mmol/l，两组之间比较有统计学意义（p＜0.01）；血清总胆红素水平观察组中位数391.8umol/l，对照组中位数51.58umol/l，两组之间比较有统计学意义（p＜0.01）；白细胞计数观察组中位数9.33*109/l，对照组中位数3.9*109/l，两组之间比较有统计学意义（p＜0.01）；血浆凝血酶原活动度（PTA）观察组34.2±17.3（%），对照组52.1±16.1（%），两组比较有显著统计学意义（p＜0.01）。Logistic回归分析结果提示肝性脑病、低血钠、总胆红素水平、凝血酶原活动度、白细胞计数可能为肝硬化腹水患者发生急性肾功能异常的独立危险因素（p＜0.05）。结论：肝硬化腹水患者伴有肝性脑病、感染、低血钠、高胆红素血症、低血浆凝血酶原活动度可能是诱发急性肾功能异常危险因素。
[Abstract]:Objective:. To investigate the risk factors of acute renal dysfunction in patients with decompensated cirrhosis and to provide reference for clinical prevention and treatment of this complication. Method. The clinical data of 254 patients with cirrhosis and ascites were collected. The patients whose serum creatinine increased more than 2 times the baseline value (> 226 渭 mol / L) within 2 weeks or more than 2 times the baseline value (> 226 渭 mol / L) were used as the observation group. Patients with serum creatinine in normal range were used as the control group. The clinical data including sex, age, etiology of cirrhosis and the relationship between clinical data and acute renal dysfunction were analyzed retrospectively. The related complications include hepatic encephalopathy, upper gastrointestinal hemorrhage, spontaneous peritonitis, SBP) and other site infections. Laboratory indicators include Albumin, total bilirubin, TBILL, and serum sodium levels. Plasma prothrombin activity (PTAA), leukocyte count (WBCU), platelet count (PLT), and serum creatinine (SCR). Sex, age, course of cirrhosis, hepatic encephalopathy, upper gastrointestinal bleeding, spontaneous peritonitis, other infection, albumin, Total bilirubin, serum sodium level, plasma prothrombin activity, leukocyte count, platelet count were analyzed by univariate analysis. Z test for plasma prothrombin activity and non-normal distribution included: total bilirubin, blood sodium level, white blood cell count and platelet count, 蠂 2 test was used for counting data, including sex, hepatic encephalopathy, upper gastrointestinal bleeding. Logistic regression analysis was used to analyze the independent risk factors of acute renal dysfunction in patients with ascites due to cirrhosis after the use of univariate analysis (P < 0.05). Results:. Univariate analysis showed that sex, age, course of cirrhosis, albumin, upper gastrointestinal bleeding, The incidence of hepatic encephalopathy was 50.4 in the observation group and 10.1 in the control group, and there were significant differences between the two groups (P < 0.01), the incidence of spontaneous peritonitis was 70.4 in the observation group and 41.2 in the control group. The incidence of infection in other sites was 32.6in the observation group, 19.3in the control group, there was significant difference between the two groups (P < 0.05); the median of serum sodium level in the observation group was 128mmol / L, and the median in the control group was 136.8 mmol / L, there was significant difference between the two groups (P < 0.01); the serum total bile duct was significantly higher than that in the control group (P < 0.01). The median of the observation group was 391.8 umol / l, the control group was 51.58 umoll / l, the comparison between the two groups was statistically significant (p < 0.01), the median of leukocyte count in the observation group was 9.33 卤109 / l, and the median in the control group was 3.9 卤109 / l, there was significant difference between the two groups (P < 0.01); the plasma prothrombin activity was significantly lower than that of the control group (P < 0.01). The observation group (34.2 卤17.3) and the control group (52.1 卤16.1) had significant statistical significance (P < 0.01) Logistic regression analysis indicated hepatic encephalopathy. Hyponatremia, total bilirubin level, prothrombin activity and white blood cell count may be independent risk factors for acute renal dysfunction in patients with ascites due to cirrhosis (p < 0.05). Conclusion:. Liver encephalopathy infection hyponatremia hyperbilirubinemia and low plasma prothrombin activity may be risk factors of acute renal dysfunction in patients with cirrhosis and ascites.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575.2;R692

【参考文献】