乙型肝炎肝硬化并发肝性脑病流行率及其危险因素分析*

doi:10.3969/j.issn.1672-5069.2025.03.022

摘要/Abstract

摘要： 目的了解乙型肝炎肝硬化患者发生肝性脑病(HE)及其危险因素情况。方法 2019年3月～2021年3月我院收治的乙型肝炎肝硬化患者60例,随访2年。行腹部CT检查并应用软件自动计算第三腰椎骨骼肌指数,行胃镜检查诊断食管静脉曲张(EV),采用West Haven评分诊断HE。应用多因素Logistic回归分析乙型肝炎肝硬化发生HE的独立危险因素。结果经过2年随访,本组患者发生HE者25例;HE组基线血清胆红素、INR、EV发生率、肝肾综合征、Child-Pugh评分、MELD评分和肌少症发生率分别为(35.3±8.5)μmol/L、(1.4±0.5)、68.0%、72.0%、(15.6±2.3)分、(21.6±2.5)分和80.0%,均显著高于肝硬化组【分别为(20.6±9.3)μmol/L、(1.2±0.3)、25.7%、17.1%、(9.2±1.6)分、(15.5±3.2)分和34.3%,P＜0.05】,而血清Alb水平、PLT计数和第三腰椎骨骼肌指数分别为(29.3±5.6)g/L、(62.3±13.5)×10⁹/L和(43.1±8.9)cm²/m²,均显著低于肝硬化组【分别为(33.2±5.9)g/L、(85.2±15.6)×10⁹/L和(46.3±8.5)cm²/m²,P＜0.05】;多因素Logistic回归分析结果显示,PLT(OR=3.442)、INR(OR=3.677)、食管静脉曲张(OR=3.647)、Child-Pugh评分(OR=4.191)、MELD评分(OR=4.614)、肌少症(OR=4.651)和第三腰椎骨骼肌指数(OR=4.468)均是影响乙型肝炎肝硬化患者发生HE的独立危险因素(P<0.05)。结论了解肝硬化患者发生HE的危险因素并及时给予干预处理,可能减少严重并发症的发生,改善预后。

关键词: 肝硬化, 肝性脑病, 危险因素, 肌少症

Abstract: Objective The purpose of this study was to investigate prevalence and risk factors of overt hepatic encephalopathy (HE) in hepatitis B-induced liver cirrhosis (LC). Methods 60 patients with hepatitis B-induced LC were recruited in our hospital between March 2019 and March 2021, and consecutively followed-up for two years. Third lumbar skeletal muscle index (L3-SMI) was obtained by abdominal CT scan, esophageal varices (EV) was determined by gastroscopy, and HE was diagnosed by West Haven score. Multivariate Logistic regression analysis was applied to find risk factors. Results HE was found in 25 cases during the two-year follow-up period; baseline serum bilirubin, INR, EV incidence, hepatorenal syndrome, Child-Pugh score, MELD score and sarcopenia incidence in patients with HE were (35.3±8.5)μmol/L, (1.4±0.5), 68.0%, 72.0%, (15.6±2.3) points, (21.6±2.5)points and 80.0%, all much higher than [(20.6±9.3)μmol/L, (1.2±0.3), 25.7%, 17.1%, (9.2±1.6)points, (15.5±3.2)points and 34.3%, respectively, P＜0.05], while serum albumin level, peripheral blood platelet count and L3-SMI were (29.3±5.6)g/L, (62.3±13.5)×10⁹/L and (43.1±8.9)cm²/m², all much lower than [(33.2±5.9)g/L, (85.2±15.6)×10⁹/L and (46.3±8.5)cm²/m², respectively, P＜0.05] in cirrhotics without HE; multivariate Logistic regression analysis showed that PLT(OR=3.442, INR(OR=3.677), EV (OR=3.647, Child-Pugh class (OR=4.191), MELD score (OR=4.614), sarcopenia (OR=4.651) and L3-SMI (OR=4.468) were all the independent risk factors for occurrence of HE in patients with LC (P<0.05). Conclusion Clinicians should take common risk factors of complications, such as HE, into consideration as dealing with patients with LC, which might improve the prognosis.

Key words: Liver cirrhosis, Overt hepatic encephalopathy, Risk factors, Sarcopenia

姚煜, 徐春阳, 任健吾. 乙型肝炎肝硬化并发肝性脑病流行率及其危险因素分析^*[J]. 实用肝脏病杂志, 2025, 28(3): 406-409.

Yao Yu, Xu Chunyang, Ren Jiangwu. Prevalence and risk factors of overt hepatic encephalopathy in hepatitis B-induced liver cirrhosis[J]. Journal of Practical Hepatology, 2025, 28(3): 406-409.

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乙型肝炎肝硬化并发肝性脑病流行率及其危险因素分析^*

Prevalence and risk factors of overt hepatic encephalopathy in hepatitis B-induced liver cirrhosis

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