肝硬化患者发生肝肾综合征的危险因素分析(1)
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[摘要] 目的：肝肾综合征(hepatorenalsyndrome，HRS)是各种肝病晚期的严重并发症，死亡率很高，预后极差，目前尚无有效的治疗措施。因此，预防HRS的发生发展是临床工作中的重要问题。由此设想，如果明确了HRS发生的危险因素，就可以对患者进行针对性的治疗以预防HRS的发生。本研究目的是探讨引起HRS的危险因素，防止HRS的发生。方法：对本院慢性肝病住院患者进行回顾性队列研究。对比在治疗过程中发生HRS患者和未发生HRS的患者，选择16个可能引起HRS的临床及理化指标，通过单因素和多因素分析，了解在HRS发生过程中的危险因素。结果：经过筛选结果显示，肝功能分级(Chlid-Pugh评分)、MELD指数、感染、PTA、放腹水次数、利尿剂量和是否行扩溶治疗，差异有统计学意义(P<0.05)，为主要危险因素。结论：改善患者的肝功能状态，合理的利尿剂和使用抗生素，有助于防止HRS的发生。
[关键词] 肝硬化；肝肾综合征；危险因素；肝病晚期
[中图分类号] R657.3+1 [文献标识码]A[文章编号]1674-4721(2011)04(a)-037-03
The analysis of risk factor of hepatorenalsyndrome in the cirrhosis patients
LIU Zhenggang
People′s Hospital of Dalang, Dongguan City, Guangdong Province, Dongguan 523770, China
[Abstract] Objectives: Hepatorenal syndrome was a form of acute or sub-acute renal failure which develops in patients with chronic liver disease. In contrast to other forms of acute renal failure it may be reversible. But there was still no effictive treament to it. So it was most important to prevent the occurrence. The aim of this study was to invetigate the dangerous factors. Methods: A retospective study was carried out. 16 possible dangerous factors including clinical and physiochemical features were analyaed between patients with cirrhosis and patients who underwent hepatorenal syndrome. Logistic regression analysis, chi-square test and indepentdent-t rest were used in our research. Results: From the logistic regression, Chlid-Pugh score，MELD index, infection, PTA, frequency of releasing abdominal, dropsy dosage of diuretica, liquid therap was the major risk factor of the patorenal syndome. Conclusion: The hepatorenal syndrome can be prevented by impoving liver function, reasonable using of the diuretic and antibiotics.
[Key words] Livere cirrhosis; Risk factors; Hepatorenal syndrome; Advanced liver disease
肝肾综合征(hepatorenal syndrome，HRS)是严重肝病患者晚期出现肝功能衰竭及门静脉高压，同时并发无器质性肾脏病变和其他原因可解释的肾功能不全的综合征[1]。该病主要出现以肾灌注显著不足的临床及生化表现，如少尿、低尿钠、血尿素及肌酐升高等为特征[2]。肾血流灌注量减少和内源性血管活性系统异常是引起该病的主要原因。肾动脉显著收缩导致肾小球滤过率减低，肾外循环则以动脉扩张为主，致全身血管阻力下降和低动脉压。由于其肾脏组织学正常或仅有轻微改变，不足以解释临床严重的肾功能损害，故又称为功能性肾衰竭(functionalrenalfailure，FRF)。HRS是各种急慢性肝衰竭终末期的严重并发症，最常见于失代偿期肝硬化和重型肝炎。肝硬化腹水无氮质血症的患者，一旦发生HRS则预后极差，死亡率高达80%～95%[3]。肝移植或联合肾移植是唯一挽救的方法[4]。确诊HRS无单一的特异指标或辅助检查，主要靠临床全面分析作出诊断。晚期肝病引起肾功能不全的危险因素众多 ......
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