本文選題：肝腎綜合征 + 發(fā)病率��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:肝腎綜合征(hepatorenal syndrome,HRS)是中晚期肝硬化患者導(dǎo)致急性腎功能衰竭的常見原因,也是嚴(yán)重影響患者預(yù)后的疾病,本文通過臨床觀察肝硬化并發(fā)肝腎綜合癥患者的臨床特點(diǎn),計算我院肝腎綜合征患者的發(fā)病率,分析導(dǎo)致肝腎綜合征的相關(guān)危險因素,并觀察特利加壓素治療肝腎綜合征的療效及影響療效的相關(guān)因素,隨后對于全部接受特利加壓素治療的患者進(jìn)行為期6個月隨訪,觀察患者的預(yù)后情況尋找影響患者預(yù)后的危險因子,為日后臨床評估患者危險性、預(yù)后及治療提供參考意見。方法:觀察我院肝膽內(nèi)科2015年1月1日至2015年12月31日共12個月內(nèi)新住院的肝硬化患者,根據(jù)是否發(fā)生肝腎綜合癥分為HRS組和非HRS組,比較兩組的患者的臨床特點(diǎn),通過單因素分析和logistic多元回歸分析確定相關(guān)危險因素,選擇全部HRS患者中接受特利加壓素1mg/6-8小時,連續(xù)治療3天以上的患者進(jìn)行第二階段的研究治療的全部肝腎綜合征患者,觀察治療的有效率及影響療效的相關(guān)因素,并對患者接受特利加壓素治療后進(jìn)行為期6個月的隨訪,觀察預(yù)后及影響預(yù)后的相關(guān)因素。結(jié)果:肝腎綜合征總體發(fā)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)、合并細(xì)菌性腹膜炎(OR 2.671,95%CI 1.251~5.693,P0.05)、MELD評分(OR 6.754,95%CI2.519~11.679,P0.01)、血鈉濃度(OR 1.892,95%CI 1.264~2.989 P0.05)、血漿白蛋白水平(OR 0.641,95%CI 0.373~0.857,P0.05)是導(dǎo)致疾病發(fā)生的相關(guān)危險因素。使用特利加壓素治療的患者總體有效率67.44%,I型HRS15人治療有效,有效率55.56%,II型HRS43人治療有效,有效率72.88%。合并細(xì)菌性腹膜炎(OR 0.143,95%CI 0.146~0.841,P0.05)、MELD評分(OR 1.644,95%CI1.089~2.482,P0.05)、發(fā)病時的eGFR水平(OR 0.770,95%CI 0.628~0.944,P0.05)與特利加壓素療效相關(guān),并且具有統(tǒng)計學(xué)意義。6個月隨訪發(fā)現(xiàn),最終有效隨訪患者86例,其中特利加壓素治療有效患者58例,無效患者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%。全部治療有效患者中復(fù)發(fā)19例,復(fù)發(fā)率32.76%。全部患者的死亡中位時間0.3305個月;并發(fā)現(xiàn)合并感染(OR 2.634,95%CI 1.251~5.659 P0.05)、MELD評分(OR4.354,95%CI 1.799~11.541,P0.05)具有統(tǒng)計學(xué)差異,與患者預(yù)后相關(guān)。結(jié)論:肝腎綜合征總體發(fā)病率較高,預(yù)后差,合并消化道出血、大量放腹水、合并細(xì)菌性腹膜炎、MELD評分與肝腎綜合征的發(fā)生正相關(guān),血鈉濃度、血漿白蛋白水平與肝腎綜合征的發(fā)生負(fù)相關(guān)。特利加壓素治療肝腎綜合征總體有效率67.44%,是否合并細(xì)菌性腹膜炎、MELD評分和發(fā)病時的eGFR水平與特利加壓素的療效相關(guān),合并感染、MELD評分與不良預(yù)后正相關(guān),使用特利加壓素可以降低治療有效患者的死亡率和延長生存期,有利于改善患者的預(yù)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 鹵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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R575;R692.5

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