肝肾综合征危险因素分析和特利加压素疗效观察与随访

发布时间：2018-05-02 09:47

本文选题：肝肾综合征 + 发病率　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:肝肾综合征(hepatorenal syndrome,HRS)是中晚期肝硬化患者导致急性肾功能衰竭的常见原因,也是严重影响患者预后的疾病,本文通过临床观察肝硬化并发肝肾综合症患者的临床特点,计算我院肝肾综合征患者的发病率,分析导致肝肾综合征的相关危险因素,并观察特利加压素治疗肝肾综合征的疗效及影响疗效的相关因素,随后对于全部接受特利加压素治疗的患者进行为期6个月随访,观察患者的预后情况寻找影响患者预后的危险因子,为日后临床评估患者危险性、预后及治疗提供参考意见。方法:观察我院肝胆内科2015年1月1日至2015年12月31日共12个月内新住院的肝硬化患者,根据是否发生肝肾综合症分为HRS组和非HRS组,比较两组的患者的临床特点,通过单因素分析和logistic多元回归分析确定相关危险因素,选择全部HRS患者中接受特利加压素1mg/6-8小时,连续治疗3天以上的患者进行第二阶段的研究治疗的全部肝肾综合征患者,观察治疗的有效率及影响疗效的相关因素,并对患者接受特利加压素治疗后进行为期6个月的随访,观察预后及影响预后的相关因素。结果:肝肾综合征总体发病率在9.13%,合并消化道出血(OR 1.578,95%CI 1.006~3.287,P0.05)、大量放腹水(OR 2.353,95%CI 1.677~4.829,P0.05)、合并细菌性腹膜炎(OR 2.671,95%CI 1.251~5.693,P0.05)、MELD评分(OR 6.754,95%CI2.519~11.679,P0.01)、血钠浓度(OR 1.892,95%CI 1.264~2.989 P0.05)、血浆白蛋白水平(OR 0.641,95%CI 0.373~0.857,P0.05)是导致疾病发生的相关危险因素。使用特利加压素治疗的患者总体有效率67.44%,I型HRS15人治疗有效,有效率55.56%,II型HRS43人治疗有效,有效率72.88%。合并细菌性腹膜炎(OR 0.143,95%CI 0.146~0.841,P0.05)、MELD评分(OR 1.644,95%CI1.089~2.482,P0.05)、发病时的eGFR水平(OR 0.770,95%CI 0.628~0.944,P0.05)与特利加压素疗效相关,并且具有统计学意义。6个月随访发现,最终有效随访患者86例,其中特利加压素治疗有效患者58例,无效患者28例。全部患者半年再入院25例,再入院率29.07%,死亡24例,死亡率27.91%。全部治疗有效患者中复发19例,复发率32.76%。全部患者的死亡中位时间0.3305个月;并发现合并感染(OR 2.634,95%CI 1.251~5.659 P0.05)、MELD评分(OR4.354,95%CI 1.799~11.541,P0.05)具有统计学差异,与患者预后相关。结论:肝肾综合征总体发病率较高,预后差,合并消化道出血、大量放腹水、合并细菌性腹膜炎、MELD评分与肝肾综合征的发生正相关,血钠浓度、血浆白蛋白水平与肝肾综合征的发生负相关。特利加压素治疗肝肾综合征总体有效率67.44%,是否合并细菌性腹膜炎、MELD评分和发病时的eGFR水平与特利加压素的疗效相关,合并感染、MELD评分与不良预后正相关,使用特利加压素可以降低治疗有效患者的死亡率和延长生存期,有利于改善患者的预后。
[Abstract]:Objective: hepatorenal syndrome (hepatorenal syndrome) is a common cause of acute renal failure (ARF) in patients with middle and late liver cirrhosis, and it is also a serious prognostic disease. To calculate the incidence of hepatorenal syndrome in our hospital, to analyze the risk factors leading to liver-renal syndrome, and to observe the curative effect of trivasopressin on hepatorenal syndrome and related factors. Then all the patients who received treponectin were followed up for 6 months. The prognosis of the patients was observed to find out the risk factors affecting the prognosis of the patients, and to provide reference for the clinical evaluation of the risk, prognosis and treatment of the patients in the future. Methods: the newly hospitalized cirrhotic patients were divided into HRS group and non-HRS group according to the occurrence of hepatorenal syndrome from January 1, 2015 to December 31, 2015. The clinical characteristics of the two groups were compared. The related risk factors were determined by univariate analysis and logistic multiple regression analysis. All patients with hepatorenal syndrome who received treponectin 1mg/6-8 hours for more than 3 days were selected for the second stage study. The effective rate of the treatment and the related factors affecting the curative effect were observed, and the patients were followed up for 6 months after the treatment with trivasopressin. The prognosis and the related factors affecting the prognosis were observed. Results: the overall incidence rate of hepatorenal syndrome was 9.13, or 1.57895 CI 1.0063.287P0.05, OR 2.35395 CI 1.6774.829 P0.05m, OR 2.67195CI 1.2515.693P0.05mLD or 6.75495CI2.511.679 P0.01P0.01, OR 1.89295CI 1.26495 CI 1.26495 CI 1.264989 P0.05, and plasma albumin level OR 0.641C 0.3730.850.75 The risk factors associated with the occurrence of the disease. The overall effective rate of patients treated with trivasopressin was 67.44g / L HRS15, and the effective rate was 55.56 / 55.56 / 2 / HRS43, and the effective rate was 72.88 and 72.88 respectively. OR 0.14395 CI 0.146n 0.841P0.05 meld score OR 1.644 + 95CI1.0892.482P0.05, OR 0.77095CI 0.6280.94P0.05) were associated with the efficacy of telitrotensin, and had statistical significance. Six months follow-up showed that 86 patients were followed up effectively. Among them, 58 effective patients and 28 ineffective patients were treated with treponopressin. All the patients were readmitted in 25 cases in half a year, the readmission rate was 29.07%, and the death rate was 27.91%. There were 19 cases of recurrence in all the effective patients, and the recurrence rate was 32.76%. The median time of death for all patients was 0.3305 months, and the OR 2.634 + 95% CI 1.251 卤5.659 P0.05 meld score OR4.35495 CI 1.799 11.541 P0.05 were found to have statistical difference, which was related to the prognosis of the patients. Conclusion: the overall incidence of hepatorenal syndrome is high, the prognosis is poor, the digestive tract hemorrhage, massive ascites and bacterial peritonitis associated with meld score are positively correlated with the occurrence of hepatorenal syndrome, and the concentration of blood sodium. The plasma albumin level was negatively correlated with the occurrence of hepatorenal syndrome. The overall effective rate of treponopressin in the treatment of hepatorenal syndrome was 67.44. The score of meld and the level of eGFR at the time of onset were correlated with the curative effect of telvasopressin, and the score of meld with infection was positively correlated with the poor prognosis. Trivasopressin can reduce the mortality and prolong the survival of effective patients, and can improve the prognosis of patients.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575;R692.5

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