中性粒细胞与淋巴细胞比值对慢加急性肝衰竭患者短期预后的评估价值

吴杜娟; 金蕾; 郜玉峰; 叶珺; 夏国美; 李芳; 邹桂舟

doi:10.3969/j.issn.1001-5256.2018.09.023

中性粒细胞与淋巴细胞比值对慢加急性肝衰竭患者短期预后的评估价值

DOI: 10.3969/j.issn.1001-5256.2018.09.023

安徽医科大学第二附属医院肝病科

基金项目:

安徽省自然科学基金资助项目(1608085MH164)；

详细信息

中图分类号: R575.3
计量
- 文章访问数: 2368
- HTML全文浏览量: 32
- PDF下载量: 390
- 被引次数: 0
出版历程
- 收稿日期: 2018-03-29
- 出版日期: 2018-09-20

Value of neutrophil-lymphocyte ratio in evaluating the short-time prognosis of patients with acute-on-chronic liver failure

Department of Hepatology, The Second Affiliated Hospital of Anhui Medical University

Research funding:

摘要

摘要:
目的研究中性粒细胞与淋巴细胞比值（NLR）对HBV相关慢加急性肝衰竭（ACLF）患者28 d预后的影响。方法回顾性分析2015年1月-2016年12月在安徽医科大学第二附属医院住院的HBV-ACLF患者100例,根据患者第28 d表现出的疾病转归状况进行分组,分别归为死亡组（n=42）或者生存组（n=58）,收集两组性别、年龄、实验室指标、MELD评分以及临床并发症情况,并对上述指标进行单因素分析,计量资料组间比较采用t检验或者Mann-Whithey U检验;计数资料组间比较采用χ2检验。多因素分析采用二元logistic回归分析。MELD评分与NLR的关系采用Pearson相关性分析,并通过受试者工作特征曲线（ROC曲线）分析不同预测指标对HBV-ACLF预后的临床价值。结果对100例HBV-ACLF患者分析显示,死亡组的年龄、Alb、ALT、肌酐、WBC、中性粒细胞计数、淋巴细胞计数、单核细胞计数、国际标准化比值、TBil、NLR、MELD评分与生存组比较,差异均有统计学意义（P值均<0.05）。生存组肝性脑病、出血、腹水、感染的发生率均低于死亡组,但组间差异均无统计学意义...
- 肝功能衰竭 /
- 淋巴细胞 /
- 中性白细胞 /
- 预后
Abstract:
Objective To investigate the effect of neutrophil-lymphocyte ratio (NLR) on the 28-day prognosis of patients with HBV-associated acute-on-chronic liver failure (HBV-ACLF) . Methods A total of 100 patients with HBV-ACLF who were admitted to The Second Affiliated Hospital of Anhui Medical University from January 2015 to December 2016 were enrolled, and according to their prognosis on day 28, they were divided into death group and survival group. The data on sex, age, laboratory markers, Model for End-Stage Liver Disease (MELD) score, and clinical complications were collected for univariate analysis. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups. The Chi-square test was used for comparison of categorical data between two groups. Binary logistic regression was used for multivariate analysis. Pearson correlation analysis was used to investigate the correlation between MELD score and NLR. The receiver operating characteristic (ROC) curve was used to analyze the value of indices in predicting the prognosis of HBV-ACLF. Results The analysis of 100 patients with HBV-ACLF showed that there were significant differences between the survival group and the death group in age, albumin, alanine transaminase, serum creatinine, white blood cell count, neutrophil count, lymphocyte count, monocyte count, international normalized ratio, total bilirubin, NLR, and MELD score (all P < 0. 05) . The survival group had lower incidence rates of hepatic encephalopathy, hemorrhage, ascites, and infection than the death group, but there were no significant differences between the two groups (all P > 0. 05) . The binary logistic regression analysis showed that NLR and MELD score were independent predictive factors for 28-day mortality in HBV-ACLF patients (P < 0. 001 and P = 0. 022) , and NLR was positively correlated with MELD score (r = 0. 264, P = 0. 008) . The ROC curve analysis showed that NLR had a significantly larger area under the ROC curve than MELD score (0. 889 vs 0.728, P =0.026 7) . Conclusion NLR is an independent predictive factor for the short-term prognosis of HBV-ACLF patients.
- liver failure /
- lymphocytes /
- neutrophils /
- prognosis

HTML全文

参考文献(16)

[1]ZHANG GL, GAO ZL.The immunological characteristics of and treatment strategies for HBV related acuteonchronic liver failure[J].Chin J Viral Dis, 2011, 1 (1) :5-8. (in Chinese) 张耿林, 高志良.乙型肝炎相关慢加急性肝衰竭的免疫学特征及治疗策略[J].中国病毒病杂志, 2011, 1 (1) :5-8.

[2]BHAT T, TELI S, RIJAL J, et al.Neutrophil to lymphocyte ratio and cardiovascular diseases:A review[J].Expert Rew Cardiovasc Ther, 2013, 11 (1) :55-59.

[3]OEHADIAN A, SURYADINATA H, DEWI S, et al.The role of neutrophyl lymphocyte count ratio as an inflammatory maker in systemic lupus erythematosus[J].Acta Med Indones, 2013, 45 (3) :170-174.

[4]WU Y, CHEN HL, ZHANG JH, et al.Correlation between neutrophil to lymphocyte ratio and coronary lesion severity in patients with acute myocardial infarction[J].Clin J Med Offic, 2016, 44 (9) :910-913. (in Chinese) 吴恽, 陈洪亮, 张君海, 等.中性粒细胞/淋巴细胞比值与急性心肌梗死相关性研究[J].临床军医杂志, 2016, 44 (9) :910-913.

[5]YILMAZ H, YALCIN KS, NAMUSLU M, et al.Neutrophil-lymphocyte ratio (NLR) could be better predictor than C-reactive protein (CRP) for liver fibrosis in non-alcoholic steatohepatitis (NASH) [J].Ann Clin Lab Sci, 2015, 45 (3) :278-286.

[6]ZHANG H, SUN Q, MAO W, et al.Neutrophil-to-lymphocyte ratio predicts early mortality in patients with HBV-related decompensated cirrhosis[J].Gastroenterol Res Pract, 2016, 2016:4394650.

[7]KWON JH, JANG JW, KIM YW, et al.The usefulness of C-reactive protein and neutrophil-to-lymphocyte ratio for predicting the outcome in hospitalized patients with liver cirrhosis[J].BMC Gastroenterol, 2015, 15:146.

[8]XU X, CHEN W, ZHANG L, et al.Prognostic significance of neutrophil to lymphocyte ratio in patients with hepatocellular carcinoma after transcatheter arterial chemoembolization[J].Chin Med J (Engl) , 2014, 127 (24) :4204-4209.

[9]LIU H, ZHANG H, WAN G, et al.Neutrophil-lymphocyte ratio:A novel predictor for short-term prognosis in acute-on-chronic hepatitis B liver failure[J].J Viral Hepat, 2014, 21 (7) :499-507.

[10] Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases CMA;Severe Liver Diseases and Artificial Liver Group, Chinese Society of Hepatology, CMA.Diagnostic and treatment guidelines for liver failure (2012 version) [J].Chin J Clin Infect Dis, 2012, 5 (6) :321-327. (in Chinese) 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南 (2012年版) [J].中华临床感染病杂志, 2012, 5 (6) :321-327.

[11]KAMATH PS, WIESNER RH, MALINCHOC M, et al.A model to predict survival in patients with end-stage liver disease[J].Hepatology, 2001, 33 (2) :464-470.

[12]ZOU Z, XU D, LI B, et al.Compartmentalization and its implication for peripheral immunologically-competent cells to the liver in patients with HBV-related acute-on-chronic liver failure[J].Hepatol Res, 2009, 39 (12) :1198-1207.

[13] HUANG SJ, WANG XL, CHENG ZJ, et al.Expression of IP-10mRNA in peripheral blood mononuclear cells is correlated with serum levels of HBs Ag and HBV DNA and of value for prognosis in patients with HBV-related acute on chronic liver failure[J].Chin JClin Infect Dis, 2016, 9 (1) :1-6. (in Chinese) 黄少军, 王晓霖, 程正江, 等.HBV相关慢加急性肝衰竭患者IP-10mRNA表达与HBs Ag和HBV DNA的相关性及其在预后评估中的价值[J].中华临床感染病杂志, 2016, 9 (1) :1-6.

[14]LU X, HAN T, LI Y, et al.Changes in levels of hepatitis B virus markers in patients with acute-on-chronic liver failure and chronic liver failure and their relationships with MELD scores[J].Shandong Med J, 2015, 55 (27) :1-3. (in Chinese) 鲁绪, 韩涛, 李莹, 等.慢加急性肝衰竭、慢性肝衰竭患者血清HBV标志物水平变化及其与MELD评分的关系[J].山东医药, 2015, 55 (27) :1-3.

[15]AGIASOTELLI D, ALEXOPOULOU A, VASILIEVA L, et al.E-valuation of neutrophil/leukocyte ratio and organ failure score as predictors of reversibility and survival following an acute-on-chronic liver failure event[J].Hepatol Res, 2016, 46 (6) :514-520.

[16]SHI XX, ZHANG YQ, ZHU P, et a I.Prognostic risk factors in patients with acute-on-chronic hepatitis B Iiver failure[J].J CIin Hepatol, 2016, 32 (4) :700-705. (in Chinese) 石新星, 张艳琼, 朱鹏, 等.乙型肝炎相关慢加急性肝衰竭患者预后的危险因素分析[J].临床肝胆病杂志, 2016, 32 (4) :700-705.

施引文献

资源附件(0)

访问统计