脓毒症患者并发急性肝功能障碍的危险因素分析(1)
[摘要] 目的 从合并症中筛选脓毒症患者并发急性肝功能障碍(AHD)的危险因素，为临床早期识别高危患者提供依据。 方法 对惠州市中心人民医院2007年1月～2013年12月收治的286例脓毒症患者资料进行回顾性分析，根据患者是否发生AHD分成两组AHD组(62例)和非AHD组(224例)，应用多因素Logistic回归模型筛选脓毒症患者并发AHD的危险因素。 结果 286例脓毒症患者中有62例发生AHD，发生率为21.68%；AHD组30 d住院病死率明显高于非AHD组[38.71%(24/62)比6.82%(15/224)，P < 0.01]。Logistic回归分析显示，高龄(OR=1.589，95%CI 1.416～1.833，P = 0.003)﹑慢性饮酒(OR = 0.906，95%CI 0.509～1.612，P = 0.038)﹑糖尿病史(OR = 1.477，95%CI 1.265～1.858，P = 0.014)﹑慢性心功能不全(OR = 1.485，95%CI 1.271～1.868，P = 0.015)﹑急性生理学与慢性健康状况评分Ⅲ(APACHE-Ⅲ)(OR = 1.505，95%CI 1.281～1.916，P = 0.023)是脓毒症患者并发AHD的高危因素。ROC曲线分析显示该模型有较高的判别AHD患者的能力，AUC为0.73(95%CI 0.68～0.91，P < 0.01)。 结论 高龄、慢性饮酒、糖尿病史、慢性心功能不全和APACHE-Ⅲ评分是脓毒症患者并发急性肝功能障碍的危险因素。
[关键词] 脓毒症；急性肝功能障碍；合并症；危险因素
[中图分类号] R459.7 [文献标识码] A [文章编号] 1673-7210(2015)01(b)-0012-04
[Abstract] Objective To explore risk factors for acute hepatic dysfunction (AHD) secondary to sepsis patients arising from comorbidities， and identify high risk patients earlier. Methods A retrospective study was conducted on 286 patients who were hospitalized with sepsis patients in the Central People's Hospital of Huizhou City， from January 2007 to December 2013. The patients were divided into two groups based on presence or absense of AHD， AHD group (62 cases) and non-AHD group (224 cases). Logistic regression analysis was used to evaluate the high risk factors for AHD. Results Among 286 hospitalized sepsis patients， 62 (21.68%) developed AHD. The 30-days in hospital mortality rate of AHD group was significantly higher than that of non-AHD group [38.71% (24/62) vs 6.82% (15/224)， P < 0.01]. On the basis of Logistic regression analysis， advanced age ( OR = 1.589， 95%CI 1.416-1.833， P = 0.003)， chronic alcohol abuse (OR = 0.906， 95%CI 0.509-1.612， P = 0.038)， history of diabetes (OR = 1.477， 95%CI 1.265-1.858， P = 0.014)， chronic heart failure (OR = 1.485， 95%CI 1.271-1.868， P = 0.015 )and APACHE-Ⅲ score (OR = 1.505， 95%CI 1.281-1.916， P = 0.023) were high risk factors for AHD. ROC curve analysis showed that， the model was shown a good quality to judge the outcome of AHD patients， and AUC was 0.73 (95%CI 0.68-0.91， P < 0.01). Conclusion The risk factors which closely related to the coccurence of AHD with sepsis are advanced age，chronic alcohol abuse， history of diabetes，chronic heart failure， APACHE-Ⅲ score.
[Key words] Sepsis； Acute hepatic dysfunction； Comorbidities； Risk factors
肝脏是脓毒症中最常见的损害靶器官，在脓毒症的病程中，急性肝功能障碍(acute hepatic dysfunction，AHD)是其最严重的并发症之一[1]。脓毒症早期即有肝脏损伤，一旦患者并发AHD，会使脓毒症进展成为严重脓毒症的概率增加，更易并发多器官功能障碍，显著增加患者病死率、延长住院时间，显著增加医疗费用[2-3]。因此，预先从脓毒症患者中筛查出可能发生AHD的高危患者，提前进行干预，对于减少脓毒症病死率及改善预后有重要的临床意义。本课题组以惠州市中心人民医院(以下简称“我院”)脓毒症患者为对象，旨在从合并症中筛选出AHD的危险因素，为临床早期识别AHD高危患者提供参考。 (翁志雄等)
[关键词] 脓毒症；急性肝功能障碍；合并症；危险因素
[中图分类号] R459.7 [文献标识码] A [文章编号] 1673-7210(2015)01(b)-0012-04
[Abstract] Objective To explore risk factors for acute hepatic dysfunction (AHD) secondary to sepsis patients arising from comorbidities， and identify high risk patients earlier. Methods A retrospective study was conducted on 286 patients who were hospitalized with sepsis patients in the Central People's Hospital of Huizhou City， from January 2007 to December 2013. The patients were divided into two groups based on presence or absense of AHD， AHD group (62 cases) and non-AHD group (224 cases). Logistic regression analysis was used to evaluate the high risk factors for AHD. Results Among 286 hospitalized sepsis patients， 62 (21.68%) developed AHD. The 30-days in hospital mortality rate of AHD group was significantly higher than that of non-AHD group [38.71% (24/62) vs 6.82% (15/224)， P < 0.01]. On the basis of Logistic regression analysis， advanced age ( OR = 1.589， 95%CI 1.416-1.833， P = 0.003)， chronic alcohol abuse (OR = 0.906， 95%CI 0.509-1.612， P = 0.038)， history of diabetes (OR = 1.477， 95%CI 1.265-1.858， P = 0.014)， chronic heart failure (OR = 1.485， 95%CI 1.271-1.868， P = 0.015 )and APACHE-Ⅲ score (OR = 1.505， 95%CI 1.281-1.916， P = 0.023) were high risk factors for AHD. ROC curve analysis showed that， the model was shown a good quality to judge the outcome of AHD patients， and AUC was 0.73 (95%CI 0.68-0.91， P < 0.01). Conclusion The risk factors which closely related to the coccurence of AHD with sepsis are advanced age，chronic alcohol abuse， history of diabetes，chronic heart failure， APACHE-Ⅲ score.
[Key words] Sepsis； Acute hepatic dysfunction； Comorbidities； Risk factors
肝脏是脓毒症中最常见的损害靶器官，在脓毒症的病程中，急性肝功能障碍(acute hepatic dysfunction，AHD)是其最严重的并发症之一[1]。脓毒症早期即有肝脏损伤，一旦患者并发AHD，会使脓毒症进展成为严重脓毒症的概率增加，更易并发多器官功能障碍，显著增加患者病死率、延长住院时间，显著增加医疗费用[2-3]。因此，预先从脓毒症患者中筛查出可能发生AHD的高危患者，提前进行干预，对于减少脓毒症病死率及改善预后有重要的临床意义。本课题组以惠州市中心人民医院(以下简称“我院”)脓毒症患者为对象，旨在从合并症中筛选出AHD的危险因素，为临床早期识别AHD高危患者提供参考。 (翁志雄等)