MELD评分联合血小板/白细胞比值对HBV相关慢加急性肝衰竭患者预后的预测价值

高心怡; 陈丽; 甘建和

doi:10.3969/j.issn.1001-5256.2021.05.019

MELD评分联合血小板/白细胞比值对HBV相关慢加急性肝衰竭患者预后的预测价值

DOI: 10.3969/j.issn.1001-5256.2021.05.019

苏州大学附属第一医院感染科，江苏苏州 215000

基金项目:

国家科技部“十三五”重大专项 (2017ZX10203201)

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：高心怡负责提出研究选题，设计研究方案，实施研究过程，采集整理数据，起草论文; 陈丽负责调研整理文献，设计论文框架，起草论文，修订论文，终审论文；甘建和负责统计分析，获取研究经费，技术或材料支持，指导性支持。

详细信息

作者简介:
高心怡(1994—)，女，主要从事肝炎、肝硬化、肝衰竭及感染性疾病的临床与基础研究

通信作者:
甘建和，ganjianhe@aliyun.com

中图分类号: R512.62
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出版历程
- 收稿日期: 2020-10-10
- 录用日期: 2020-11-03
- 出版日期: 2021-05-20

Value of Model for End-Stage Liver Disease score combined with platelet-to-white blood cell ratio in predicting the prognosis of patients with hepatitis B virus-associated acute-on-chronic liver failure

Department of Infectious Diseases, The First Affiliated Hospital of Suzhou University, Suzhou, Jiangsu 215000, China

摘要

摘要: 目的探讨终末期肝病模型(MELD)评分系统联合血小板/白细胞比值(PWR)在预测HBV相关慢加急性肝衰竭(HBV-ACLF)短期预后中的价值。方法回顾性分析2014年6月—2019年6月苏州大学附属第一医院收治的123例HBV-ACLF患者的临床资料，根据其入院后90 d的预后分为生存组(n=53)和死亡组(n=70)。记录患者的年龄、性别及入院24 h内患者TBil、ALT、AST、GGT、ALP、SCr、Alb、前白蛋白(PAB)、INR、WBC、淋巴细胞计数(LY)、单核细胞计数(MO)、中性粒细胞计数(NE)、Hb、PLT，并计算PWR和MELD评分。计量资料2组间比较采用t检验或Mann-Whitney U检验，单因素及多因素二元logistic回归分析各因素与HBV-ACLF预后的关系，并建立MELD评分联合PWR的预测模型。绘制受试者工作特征曲线(ROC曲线)，并计算约登指数、临界值、敏感度、特异度，比较单独MELD评分和MELD评分联合PWR的ROC曲线下面积(AUC)，比较两者评价HBV-ACLF患者预后的价值。结果两组患者TBil、ALT、SCr、INR、WBC、MO、NE、Hb、PLT、PWR和MELD评分比较差异均有统计学意义(P值均＜0.05)。单因素分析显示，TBil、SCr、INR、WBC、MO、NE、MELD评分对HBV-ACLF患者的预后有影响(P值均＜0.05)。多因素分析显示，PWR(OR=0.883, 95%CI: 0.798~0.977, P=0.016)和MELD评分(OR=1.442, 95%CI: 1.225~1.698, P＜0.001)为HBV-ACLF患者预后的独立影响因素。MELD评分联合PWR(AUC=0.895，95%CI：0.827~0.943)对HBV-ACLF患者预后的预测能力高于单独MELD评分(AUC=0.842，95%CI：0.765~0.902)，差异有统计学意义(P＜0.05)。结论 MELD评分联合PWR可以提高MELD评分预测HBV-ACLF患者预后的预测效能。
- 慢加急性肝功能衰竭 /
- 乙型肝炎病毒 /
- 预后
Abstract: Objective To investigate the value of Model for End-Stage Liver Disease (MELD) score combined with platelet-to-white blood cell ratio (PWR) in predicting the short-term prognosis of patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF). Methods A retrospective analysis was performed for the clinical data of 123 HBV-ACLF patients who were admitted to The First Affiliated Hospital of Suzhou University from June 2014 to June 2019, and according to the prognosis on day 90 after admission, these patients were divided into survival group with 53 patients and death group with 70 patients. Related clinical data were recorded, including age, sex, and total bilirubin (TBil), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), serum creatinine (SCr), Albumin (Alb), prealbumin (PAB), international normalized ratio (INR), white blood cell count (WBC), lymphocyte count (LY), monocyte count (MO), neutrophil count (NE), hemoglobin (Hb), and platelet count (PLT) within 24 hours after admission, and PWR and MELD score were calculated. The t-test and the Mann-Whitney U test were used for comparison of continuous data between two groups; univariate and multivariate binary logistic regression analyses were used to analyze the association between each factor and the prognosis of HBV-ACLF; a predictive model of MELD score combined with PWR was established. The receiver operating characteristic (ROC) curve was plotted, and Youden index, cut-off value, sensitivity, and specificity were calculated; the area under the ROC curve (AUC) was calculated for MELD score alone or combined with PWR to compare their value in predicting the prognosis of HBV-ACLF patients. Results There were significant differences between the two groups in TBil, ALT, SCr, INR, WBC, MO, NE, Hb, PLT, PWR, and MELD score (all P < 0.05). TBil, SCr, INR, WBC, MO, NE, and MELD score were risk factors for prognosis of HBV-ACLF patients(all P < 0.05); PWR (odds ratio [OR]=0.883, 95% confidence interval [CI]: 0.798-0.977, P=0.016) and MELD score (OR=1.442, 95%CI: 1.225-1.698, P < 0.001) were independent predictive factors for the prognosis of HBV-ACLF patients. MELD score combined with PWR had a stronger predictive efficiency than MELD score alone in predicting the prognosis of HBV-ACLF patients [0.895 (95%CI: 0.827-0.943) vs 0.842 (95%CI: 0.765-0.902), P < 0.05]. Conclusion MELD score combined with PWR can improve the efficiency of MELD score alone in predicting the prognosis of HBV-ACLF patients.
- Acute-On-Chronic Liver Failure /
- Hepatitis B Virus /
- Prognosis

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图 1 MELD联合PWR的ROC曲线

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表 1 两组患者一般资料比较

指标	生存组(n=53)	死亡组(n=70)	统计值	P值
年龄(岁)	47.81±14.66	52.34±11.84	t=-1.897	0.112
TBil(μmol/L)	287.80(231.10~368.65)	350.60(257.83~457.40)	Z=-2.316	0.021
ALT(U/L)	472.00(227.50~889.55)	247.20(59.45~728.00)	Z=-2.155	0.031
AST(U/L)	275.00(124.55~626.20)	210.60(92.75~520.50)	Z=-0.950	0.342
GGT(U/L)	99.40(65.50~142.05)	81.50(51.50~123.88)	Z=-1.785	0.074
ALP(U/L)	127.70(108.50~163.05)	137.00(104.30~164.23)	Z=-0.020	0.984
SCr(μmol/L)	58.00(49.70~66.00)	70.00(53.50~111.38)	Z=-3.210	0.001
Alb(g/L)	32.17±4.11	30.58±5.30	t=1.818	0.231
PAB(mg/L)	39.20(28.70~59.00)	41.45(28.90~64.60)	Z=-0.444	0.657
INR	1.81(1.68~2.02)	2.56(2.01~3.22)	Z=-5.480	＜0.001
WBC(10⁹/L)	5.92(4.47~8.02)	9.48(6.42~12.07)	Z=-4.446	＜0.001
LY(10⁹/L)	1.01(0.75~1.47)	0.92(0.61~1.24)	Z=-1.918	0.055
MO(10⁹/L)	0.42(0.29~0.65)	0.61(0.35~0.90)	Z=-2.541	0.011
NE(10⁹/L)	4.21(2.97~5.77)	7.49(4.63~10.29)	Z=-4.334	＜0.001
Hb(g/L)	132(115~148)	120(87~141)	Z=-2.166	0.018
PLT(10⁹/L)	100(76~129)	80(45~110)	Z=-2.745	0.006
PWR	16.57(11.35~23.59)	8.97(4.64~15.12)	Z=-4.985	＜0.001
MELD评分	20.18(18.17~22.06)	26.57(22.52~30.93)	Z=-6.481	＜0.001

下载: 导出CSV

表 2 单因素logistics分析

指标	OR	95%CI	P值
TBil	1.004	1.001~1.007	0.017
ALT	1.000	0.999~1.000	0.718
SCr	1.032	1.013~1.051	0.001
INR	6.119	2.669~14.025	＜0.001
WBC	1.226	1.096~1.372	＜0.001
MO	2.731	1.031~7.230	0.043
NE	1.282	1.126~1.458	＜0.001
Hb	0.983	0.970~0.996	0.010
PLT	0.994	0.987~1.000	0.067
PWR	0.870	0.819~0.925	＜0.001
MELD评分	1.386	1.217~1.578	＜0.001

下载: 导出CSV

表 3 MELD评分及MELD评分联合PWR预测HBV-ACLF患者预后的ROC曲线

指标	AUC	约登指数	临界值	敏感度(%)	特异度(%)
MELD评分	0.842	0.593	22.315	80.00	79.25
MELD评分联合PWR	0.895	0.696	0.507	77.14	92.45

下载: 导出CSV

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