摘要
目的分析重症急性肝衰竭患儿的临床特点,探讨影响重症急性肝衰竭患儿预后的危险因素,为其临床诊治和预后判断提供依据。方法分析湖南省儿童医院2011年1月至2017年1月符合诊断标准的85例急性肝衰竭患儿的病历资料,根据急性肝衰竭患儿的预后,将所有患儿分为存活组(49例)和死亡组(36例)。采用单因素和多因素Logistic回归方法分析影响急性肝衰竭患儿预后的危险因素。结果急性肝衰竭患儿存活组酶胆分离[26.5%(13/49例)比55.6%(20/36例),χ^2=7.361,P=0.007]、肝性脑病[16.3%(8/49例)比38.9%(14/36例),χ2=5.507,P=0.019]、总胆红素[72.30(3.93~428.80)μmol/L比153.08(3.23~776.26)μmol/L,U=-2.283,P=0.027]、清蛋白[35.02(22.89~45.30)g/L比28.90(18.30~40.26)g/L,U=4.640,P=0.000]、丙氨酸转氨酶[1626.10(23.01~9518.41)U/L比533.08(7.02~5163.83)U/L,U=2.992,P=0.004]、天冬氨酸氨基转移酶[1611.20(34.51~15850.02)U/L比715.54(60.06~10280.42)U/L,U=2.312,P=0.023]、血氨[71.02(16.04~148.56)μmol/L比81.02(33.04~274.02)μmol/L,U=-2.057,P=0.046]、凝血酶原时间[23.10(13.61~81.23)s比33.91(12.62~84.57)s,U=-2.364,P=0.022]、活化部分凝血酶原时间[52.91(4.02~181.02)s比67.35(31.20~180.02)s,U=-2.226,P=0.029]、终末期肝病模型评分[13.00(-9.00~52.00)分比27.50(-9.00~88.00)分,U=-3.082,P=0.003]与死亡组比较差异均有统计学意义。多因素Logistic回归分析显示,总胆红素(OR=0.236,95%CI:0.059~0.946,P=0.041)、清蛋白(OR=0.854,95%CI:0.746~0.976,P=0.019)、酶胆分离(OR=1.063,95%CI:1.031~1.119,P=0.005)和肝性脑病(OR=1.439,95%CI:1.021~2.043,P=0.017)是影响急性肝衰竭患儿预后的危险因素。结论重症儿童急性肝衰竭总胆红素越高、清蛋白越低、并酶胆分离和肝性脑病者其预后越差。
Objective To analyze the clinical features of acute liver failure in critically ill children,to investigate the risk factors affecting the prognosis of acute liver failure in critically ill children,and to provide evidence for clinical diagnosis and prognosis.Methods The data of 85 children with acute liver failure who conformed to the diagnostic criteria from January 2011 to January 2017 at Hunan Children′s Hospital were analyzed.According to the prognosis of children with acute liver failure,all children were divided into the survival group(49 cases)and the death group(36 cases).Univariate and multivariate Logistic regression methods were used to analyze the risk factors affecting the prognosis of children with acute liver failure.Results There were statistically significant differences of enzyme bile isolation[26.5%(13/49 cases)vs.55.6%(20/36 cases),χ2=7.361,P=0.007],hepatic encephalopathy[16.3%(8/49 cases)vs.38.9%(14/36 cases),χ2=5.507,P=0.019],total bilirubin[72.30(3.93-428.80)μmol/L vs.153.08(3.23-776.26)μmol/L,U=-2.283,P=0.027],albumin[35.02(22.89-45.30)g/L vs.28.90(18.30-40.26)g/L,U=4.640,P=0.000],alanine aminotransferase[1 626.10(23.01-9 518.41)U/L vs.533.08(7.02-5 163.83)U/L,U=2.992,P=0.004],aspartate aminotransferase[1 611.20(34.51-15 850.02)U/L vs.715.54(60.06-10 280.42)U/L,U=2.312,P=0.023],blood ammonia[71.02(16.04-148.56)μmol/L vs.81.02(33.04-274.02)μmol/L,U=-2.057,P=0.046],prothrombin time[23.10(13.61-81.23)s vs.33.91(12.62-84.57)s,U=-2.364,P=0.022],activated partial prothrombin time[52.91(4.02-181.02)s vs.67.35(31.20-180.02)s,U=-2.226,P=0.029],and end-stage liver disease model score[13.00(-9.00-52.00)score vs.27.50(-9.00-88.00)score,U=-3.082,P=0.003]in the children with acute liver failure between the survival group and the death group.Multivariate Logistic regression analysis showed that total bilirubin(OR=0.236,95%CI:0.059-0.946,P=0.041),albumin(OR=0.854,95%CI:0.746-0.976,P=0.019),enzyme bile separation(OR=1.063,95%CI:1.031-1.119,P=0.005)and hepatic encephalopathy(OR=1.439,95%CI:1.021-2.043,P=0.017)were risk factors for the prognosis of children with acute liver failure.Conclusions The level of the total bilirubin and the ratio of enzyme bile isolation and hepatic encephalopathy are positively correlated but the level of albumin is negatively correlated with the prognosis of critically ill children with acute liver failure.
作者
罗兰
刘萍萍
隆彩霞
周海银
Luo Lan;Liu Pingping;Long Caixia;Zhou Haiyin(Emergency Center,Hunan Children′s Hospital,Changsha 410007,China)
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2019年第18期1390-1393,共4页
Chinese Journal of Applied Clinical Pediatrics
基金
"十二五"国家科技支撑计划(2012BAI04B01)
湖南省自然科学基金青年基金(2018JJ3273)
湖南省科技厅重点实验室项目(2018TP1028).
关键词
危重症
儿童
急性肝衰竭
预后
Critically ill
Child
Acute liver failure
Prognosis
