不同病因肝硬化患者临床特征及其预后影响因素分析

摘要 目的：探讨不同病因肝硬化患者临床特征及其预后影响因素。方法：回顾性选择2017年1月至2020年12月来我院诊治的具有完整资料，同时明确诊断为肝硬化，病因为乙肝后肝硬化（78例）、酒精性肝硬化（42例）。分析两组患者的一般资料、并发症发生情况、合并疾病情况，分析乙肝后肝硬化、酒精性肝硬化患者的预后影响因素。结果：两组患者在性别、职业、临床表现（黄疸、黑便、呕血、蜘蛛痣、脾脏增大）、肝脏体积缩小、并发症（上消化道出血、肝性脑病）、合并疾病（脂肪肝、糖尿病、胰腺炎、胆结石）方面有统计学意义（P<0.05）。乙肝后肝硬化组的疾病进展发生率明显较酒精性肝硬化组高（P<0.05）。单因素分析结果表明，临床表现（乏力、食欲减退、皮肤瘙痒、腹痛、腹胀、呕血、黑便、腹水）、Child-Pugh分级、并发症（上消化道出血、肝性脑病）是影响乙肝后肝硬化患者预后的因素（P<0.05）；Logistic回归分析结果表明，Child-Pugh分级在B、C级、存在上消化道出血与肝性脑病是影响乙肝后肝硬化患者预后的危险因素（P<0.05）。单因素分析结果表明，临床表现（黄疸）、Child-Pugh分级、并发症（上消化道出血、肝性脑病、感染）是影响酒精性肝硬化患者预后的因素（P<0.05）；Logistic回归分析结果表明，Child-Pugh分级为C级、存在上消化道出血肝性脑病、感染是影响酒精性肝硬化患者预后的危险因素（P<0.05）。结论：乙肝后肝硬化与酒精性肝硬化的差异主要体现在性别、职业、临床表现、并发症与合并疾病中，影响乙肝后肝硬化预后的危险因素为Child-Pugh分级在B、C级、存在上消化道出血与肝性脑病，影响酒精性肝硬化预后的危险因素为Child-Pugh分级为C级、存在上消化道出血、肝性脑病、感染，需防治并发症，以改善患者预后。

Analysis of Clinical Features and Prognostic Factors of Patients with Cirrhosis of Different Etiology

ABSTRACT Objective: To investigate the clinical characteristics and prognostic factors of patients with cirrhosis of different etiology. Methods: Complete data of patients who came to our hospital from January 2017 to December 2020 were retrospectively selected. At the same time, they were diagnosed as cirrhosis, which was caused by postheb cirrhosis (78 cases) and alcoholic cirrhosis (42 cases).The general data, complications and diseases of the two groups were analyzed, and the prognostic factors of patients with posthepatitis B cirrhosis and alcoholic cirrhosis were analyzed. Results: There were statistical significance in gender, occupation, clinical manifestations (jaundice, black stool, hematemesis, spider naevi, spleen enlargement), liver size reduction, complications (upper digestive tract hemorrhage, hepatic encephalopathy), and concomitant diseases (fatty liver, diabetes, pancreatitis, gallstones) of the two groups (P<0.05). The incidence of disease progression was significantly higher in the postheb cirrhosis group than in the alcoholic cirrhosis group (P<0.05). The incidence of disease progression was significantly higher in the postheb cirrhosis group than in the alcoholic cirrhosis group (P<0.05). The results of single factor analysis showed that clinical manifestations (fatigue, loss of appetite, pruritus, abdominal pain, abdominal distension, hematemesis, black stool, ascites), Child-Pugh grade, complications (upper digestive tract hemorrhage, hepatic encephalopathy) were the factors affecting the prognosis of patients with posthepatitis B cirrhosis(P<0.05). Logistic regression analysis showed that Child-Pugh grades in B and C, the presence of upper gastrointestinal bleeding and hepatic encephalopathy were risk factors for the prognosis of patients with posthepatitis B cirrhosis (P<0.05). Unifactorial analysis showed that clinical manifestations (jaundice), Child-Pugh grade, complications (upper gastrointestinal bleeding, hepatic encephalopathy, infection) were the prognostic factors of alcoholic cirrhosis(P<0.05). Logistic regression analysis showed that Child-Pugh grade C, the presence of upper gastrointestinal bleeding hepatic encephalopathy and infection were the risk factors affecting the prognosis of patients with alcoholic cirrhosis (P<0.05). Conclusion: The differences between posthepatitis B cirrhosis and alcoholic cirrhosis are mainly reflected in gender, occupation, clinical manifestations, complications and co-diseases. The risk factors affecting prognosis of posthepatitis B cirrhosis are Child-Pugh grade B and C, the presence of upper gastrointestinal bleeding and hepatic encephalopathy. The risk factors affecting the prognosis of alcoholic cirrhosis are Child-Pugh grade C, the presence of upper gastrointestinal bleeding, hepatic encephalopathy, infection, complications need to be prevented to improve the prognosis of patients.