本文關(guān)鍵詞： 肝硬化失代償期 急性腎功能異常 腹水 單因素分析 Logistic回歸分析　出處：《安徽醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的： 探討失代償期肝硬化患者發(fā)生急性腎功能異常的危險(xiǎn)因素，為臨床防治該并發(fā)癥提供參考依據(jù)。 方法 收集254例肝硬化伴有腹水患者的相關(guān)臨床資料,將2周內(nèi)血肌酐上升超過(guò)正常值高限,或者2周內(nèi)血肌酐上升超過(guò)基線值2倍以上（大于226μmol/L）的患者，作為觀察組，將血肌酐在正常范圍的患者作為對(duì)照組，回顧性分析入選病例基礎(chǔ)臨床資料及相關(guān)實(shí)驗(yàn)室指標(biāo)與急性腎功能異常的關(guān)系。臨床基礎(chǔ)資料包括：性別、年齡、肝硬化病因、肝硬化病程、以及轉(zhuǎn)歸；相關(guān)并發(fā)癥包括：肝性腦�。℉E）、上消化道出血、自發(fā)性腹膜炎（SBP）以及其他部位感染；實(shí)驗(yàn)室指標(biāo)包括：白蛋白(ALB)、總膽紅素(TBIL)、血鈉水平、血漿凝血酶原活動(dòng)度（PTA）、白細(xì)胞計(jì)數(shù)(WBC)、血小板計(jì)數(shù)（PLT）、以及血肌酐。對(duì)入選指標(biāo)：性別、年齡、肝硬化病程、肝性腦病、上消化道出血、自發(fā)性腹膜炎、其他部位感染、白蛋白、總膽紅素、血鈉水平、血漿凝血酶原活動(dòng)度、白細(xì)胞計(jì)數(shù)、血小板計(jì)數(shù)進(jìn)行單因素分析，其中計(jì)量資料符合正態(tài)分布的采用t檢驗(yàn)，其中包括年齡、肝硬化病程、白蛋白、血漿凝血酶原活動(dòng)度，不符合正態(tài)分布的采用Z檢驗(yàn)包括：總膽紅素、血鈉水平、白細(xì)胞計(jì)數(shù)以及血小板計(jì)數(shù)；計(jì)數(shù)資料采用χ2檢驗(yàn)，包括：性別、肝性腦病、上消化道出血、自發(fā)性腹膜炎、其他部位感染。在使用單因素分析之后，，對(duì)單因素分析有統(tǒng)計(jì)學(xué)意義（p＜0.05）的指標(biāo)采用Logistic回歸分析，觀察肝硬化腹水患者發(fā)生急性腎功能異常的獨(dú)立危險(xiǎn)因素。 結(jié)果： 單因素分析結(jié)果提示性別、年齡、肝硬化病程、白蛋白、上消化道出血，觀察組與對(duì)照組比較無(wú)統(tǒng)計(jì)學(xué)意義（p〉0.05）。肝性腦病發(fā)生率觀察組占50.4%，對(duì)照組10.1%；兩組之間比較有統(tǒng)計(jì)學(xué)意義（p＜0.01），自發(fā)性腹膜炎發(fā)生率觀察組70.4%，對(duì)照組41.2%，兩組之間比較有統(tǒng)計(jì)學(xué)意義（p＜0.01）；其他部位感染發(fā)生率觀察組32.6%，對(duì)照組19.3%，兩組之間比較有統(tǒng)計(jì)學(xué)意義（p＜0.05）；血鈉水平觀察組中位數(shù)128mmol/l，對(duì)照組中位數(shù)136.8mmol/l，兩組之間比較有統(tǒng)計(jì)學(xué)意義（p＜0.01）；血清總膽紅素水平觀察組中位數(shù)391.8umol/l，對(duì)照組中位數(shù)51.58umol/l，兩組之間比較有統(tǒng)計(jì)學(xué)意義（p＜0.01）；白細(xì)胞計(jì)數(shù)觀察組中位數(shù)9.33*109/l，對(duì)照組中位數(shù)3.9*109/l，兩組之間比較有統(tǒng)計(jì)學(xué)意義（p＜0.01）；血漿凝血酶原活動(dòng)度（PTA）觀察組34.2±17.3（%），對(duì)照組52.1±16.1（%），兩組比較有顯著統(tǒng)計(jì)學(xué)意義（p＜0.01）。Logistic回歸分析結(jié)果提示肝性腦病、低血鈉、總膽紅素水平、凝血酶原活動(dòng)度、白細(xì)胞計(jì)數(shù)可能為肝硬化腹水患者發(fā)生急性腎功能異常的獨(dú)立危險(xiǎn)因素（p＜0.05）。 結(jié)論： 肝硬化腹水患者伴有肝性腦病、感染、低血鈉、高膽紅素血癥、低血漿凝血酶原活動(dòng)度可能是誘發(fā)急性腎功能異常危險(xiǎn)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 鹵109 / l, and the median in the control group was 3.9 鹵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 鹵17.3) and the control group (52.1 鹵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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R575.2;R692

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