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目的 通过 4 77例重型病毒性肝炎的临床总结 ,探讨重型病毒性肝炎预后的影响因素。方法 对 4 77例重型病毒性肝炎临床资料进行回顾性分析。结果 急性重型病毒性肝炎 ,亚急性重型病毒性肝炎及慢性重型病毒性肝炎病死率分别为87.5% ,78.7%和 72 .5% ,三者之间无明显差异 ,与性别无关 (P >0 .0 5) ;年龄大于 50岁者病死率为 85.1 % ,预后差 ,但病死组病人血清胆红素 [( 4 0 8.5± 1 0 4 .1 ) μmol/L]、肝性脑病 ( 6 7.1 % )、消化道出血 ( 2 8.0 % )、肝肾综合征 ( 31 .1 % )及严重感染 ( 38.6 % )发生率明显高于好转或治愈组 [( 36 7.4± 1 1 2 .5) μmol/L ,1 8.1 % ,1 3.5% ,0 ,2 1 .3% ,P <0 .0 1 ];凝血酶原活动度 ( 2 5.7%± 7.1 % )明显低于好转或治疗愈组 [( 34 .4± 5.4 ) % ,P <0 .0 1 ]。结论 高龄 ,高胆红素 ,凝血酶原活动度降低并发肝性脑病、消化道出血、肝肾综合征及严重感染是重型肝炎预后不良的因素。
Objective To discuss the prognostic factors of severe viral hepatitis through the clinical summary of 4 77 cases of severe viral hepatitis. Methods The clinical data of 4 77 cases of severe viral hepatitis were retrospectively analyzed. Results The mortality rates of acute severe hepatitis, subacute severe hepatitis and chronic severe hepatitis were 87.5%, 78.7% and 72.5%, respectively. There was no significant difference among them, which was not related to gender (P> 0.05). The mortality rate was 85.1% in patients over 50 years of age and the prognosis was poor. However, serum bilirubin [(48.0 ± 10.4) μmol / L], hepatic encephalopathy (7.1 7.1% ), Gastrointestinal bleeding (28.0%), hepatorenal syndrome (31.1%) and severe infection (38.6%) were significantly higher than those in the improvement or cure group [(36 7.4 ± 112.4) μmol / (P <0.01). The activity of prothrombin (25.7% ± 7.1%) was significantly lower than that of the improvement or treatment group .4 ± 5.4)%, P <0.01]. Conclusions Elderly, hyperbilirubinemia and prothrombin activity are associated with hepatic encephalopathy, gastrointestinal bleeding, hepatorenal syndrome and severe infection are the prognostic factors of severe hepatitis.