Retrospective Analysis Of Influential Factors In Hepatitis B Virus Related Cirrhosis With Hepatic Encephalopathy

Objective:To prevent hepatic encephalopathy (HE) and improving the prognosis, we investigated the influential factors in the process of the occurrence and development of hepatitis B virus related cirrhosis with hepatic encephalopathy (HBCE).Methods:87 HBCE and 13 hepatitis B virus related cirrhosis without HE (HBCNE) inpatients with complete data in the First Affiliated Hospital of Dalian Medical University during March 2002 and March 2010 were enrolled in the study. The clinical data of gender, age, precipitating factors, ascites, esophageal and/or fundic varices, splenomegaly, grade of HE, Child-Pugh grade, and the laboratory indices of blood ammonia, serum sodium, serum cholinesterase, serum total bilirubin, serum albumin, blood urea nitrogen, serum creatinine, prothrombin time were collected respectively.Results1. Precipitating factors of HBCE included infection 31 (35.6%), upper gastrointestinal bleeding 14 (16.1%), high protein-diet uptake 14 (16.1%), electrolyte disorders 6 (6.9%), renal inadequacy 4 (4.6%), constipation 4 (4.6%), iatrogenic factors 4 (4.6%) and other factors 10 (11.4%). Of the 87 inpatients,15 (17.2%),32 (36.8%),18 (20.7%),22 (25.3%) were grade I II, III andâ…£respectively, according to the West Haven standard for HE grade.2. Child-Pugh grade, ascites, blood ammonia, serum sodium, serum cholinesterase, serum total bilirubin, serum albumin, blood urea nitrogen, and prothrombin time were significantly different between groups of HBCE and HBCNE (P<0.05). 3. Of the 87 inpatients, the level of blood ammonia in grade IV was increased than in other grades (P<0.05). Compared to grade I, the level of serum sodium in grade II,â…¢and IV were apparently decreased (P<0.05), and serum cholinesterase in grade IV was declined (P<0.05). The level of blood urea nitrogen in grade IV was higher than in grade I and II (P< 0.05).4. No variance of blood ammonia was revealed among various precipitating factors, Child-Pugh grade, display of portal hypertension existed whether or not on HBCE inpatients (P>0.05).Conclusions1. Infection was the most common precipitating factor to induce hepatic encephalopathy with hepatitis B virus related cirrhosis, and preventing and controlling infection could decrease the incidence of hepatic encephalopathy.2. High level of blood ammonia, serum total bilirubin and blood urea nitrogen, low level of serum sodium, serum cholinesterase and serum albumin, Child-Pugh grade C, ascites, prolong prothrombin time could increase the incidence of hepatitis B virus related cirrhosis with hepatic encephalopathy.3. High level of blood ammonia and blood urea nitrogen, low serum sodium and serum cholinesterase could make more severe on grade of hepatic encephalopathy and influence prognosis of hepatitis B virus related cirrhosis with hepatic encephalopathy.