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摘要：
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摘要：目的 回顾性分析96例肝功能衰竭患者的临床特点、主要并发症和预后的关系。方法 收集2008
年1月至2014年12月首都医科大学附属北京地坛医院收治的96例肝衰竭患者的临床资料，分析肝性
脑病、上消化道出血、肝肾综合征、腹水和腹腔感染等主要并发症与预后的关系。结果 ①96例肝功
能衰竭患者中男性68例，女性28例，平均年龄（44.91 ± 13.30）岁。存活60例，平均年龄（43.60 ±
11.14）岁，病死36例，平均年龄（47.18 ± 16.32）岁，差异无统计学意义（t = 1.120，P = 0.268）。
②根据发病速度、严重程度和基础肝病情况，96例患者中亚急性肝功能衰竭17例（17.71%），慢
性肝炎基础上的慢加急/亚急性肝功能衰竭17例（17.71%），肝硬化基础上的慢性肝功能衰竭62例
（64.58%）。有肝性脑病表现者60例（62.50%）。③所有患者中病死36例，总体病死率为37.50%。
单因素分析表明上消化道出血、肝性脑病和肝肾综合征与肝功能衰竭患者病死显著相关（χ 2 = 10.41，
P = 0.001；χ 2 = 13.70，P ＜ 0.001；χ 2 = 42.84，P ＜ 0.001）。并发肝性脑病患者的病死率显著高
于未并发者（51.67% vs 13.89），差异有统计学意义（χ 2 = 13.70，P ＜ 0.001）。多因素分析表明
Ⅲ、Ⅳ期肝性脑病和肝肾综合征是肝功能衰竭患者病死的独立预测因素（OR = 30.509，95%CI：
6.212～149.845；OR = 69.161，95%CI：12.216～391.571）。结论 Ⅲ、Ⅳ期肝性脑病和肝肾综合征是
肝功能衰竭病死的独立预测因素。
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Abstract: Objective To investigate the relationship among clinical features, main complications and
prognosis of 96 patients with liver failure retrospectively. Methods The clinical data of 96 cases with
liver failure in Beijing Ditan Hospital, Capital Medical University from January 2008 to December 2014
were collected, the relationship between main complications including hepatic encephalopathy, upper
gastrointestinal bleeding, hepatorenal syndrome, ascites, abdominal infection and prognosis were analyzed.
Results ①In the 96 cases with liver failure, there were 68 males and 28 females with an average age of
(44.91 ± 13.30) years; there were 60 patients who were survived with an average age of (43.60 ± 11.14) years
and 36 patients who were dead with an average age of (47.18 ± 16.32) years, the difference was statistically
significant (t = 1.120, P = 0.268). ②According to the progression rate of hepatitis and basic liver conditions,
total of 17 cases (17.71 %) cases were subacute liver failure, 17 cases (17.71%) were acute-on-chronic/
subacute liver failure based on chronic hepatitis and 62 cases (64.58 %) were cirrhosis liver failure. Clinical
manifestations with hepatic encephalopathy accounted for 62.50% (60 cases). ③Total of 36 patients died
and the overall mortality was 37.50%. Single factor analysis showed that upper gastrointestinal hemorrhage,
hepatic encephalopathy and hepatorenal syndrome were significantly associated with death in patients with
liver failure (χ 2 = 10.41, P = 0.001; χ 2 = 13.70, P ＜ 0.001; χ 2 = 42.84, P ＜ 0.001). The mortality of patients
with hepatic encephalopathy was significantly higher than that of patients without hepatic encephalopathy
(51.67% vs 13.89%), the difference was statistically significant (χ 2 = 13.70，P ＜ 0.001). Multifactorial
logistic regression analysis showed that Ⅲ and Ⅳ phase hepatic encephalopathy and hepatorenal syndrome
were independent risk factors for liver failure (OR = 30.509, 95%CI: 6.212～149.845; OR = 69.161, 95%CI:
12.216～391.571). Hepatic encephalopathy III and IV mortality rate was 10/14 (85.71 %). Conclusion
Hepatic encephalopathy (severe than Ⅲ phase) and hepatorenal syndrome were independent risk factors for
patients of liver failure.
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