HBV相关慢加急性肝衰竭患者90天预后影响因素分析

张冬青; 郑瑞丹; 林明华; 吴雯军; 林升龙; 王香梅; 马华皙; 李芹; 叶寒辉; 高海兵

doi:10.3969/j.issn.1001-5256.2021.10.011

HBV相关慢加急性肝衰竭患者90天预后影响因素分析

DOI: 10.3969/j.issn.1001-5256.2021.10.011

1.
福建医科大学孟超肝胆医院肝病科，福州 350025
2.
漳州正兴医院肝病科，福建漳州 363000

基金项目:

福州市卫生健康科技计划项目 (2019-S-wq18);

福建省医学创新课题 (2020CXB038);

“艾滋病和病毒性肝炎等重大传染病防治”科技重大专项课题 (2017ZX10203201);

福州市感染性疾病医学中心资助 (2018080306);

福建省临床重点专科建设项目资助 (Min-wei medical political letter 2018, 145)

详细信息

通信作者:
高海兵，gaohb605@163.com

中图分类号: R512.62;R575.3
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出版历程
- 收稿日期: 2021-04-26
- 录用日期: 2021-06-08
- 出版日期: 2021-10-20

Influencing factors for the 90-day prognosis of patients with HBV-related acute-on-chronic liver failure

1.
Department of Hepatology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China
2.
Department of Hepatology, Zhangzhou Zhengxing Hospital, Zhangzhou, Fujian 363000, China

Research funding:

Health Science and Technology Project of Fuzhou City (2019-S-wq18);

Medical Innovation Project of Fujian Province (2020CXB038);

The National Key Special Program for The Control and Treatment of Major Infectious Diseases of AIDS and Viral Hepatitis (2017ZX10203201);

Infectious Disease Medical Center Construction Program of Fuzhou City (2018080306);

The Key Clinical Specialty Discipline Construction Program of Fujian Province (Min-wei medical political letter 2018, 145)

摘要

摘要: 目的探讨影响HBV相关慢加急性肝衰竭患者短期预后的危险因素。方法回顾性分析2019年10月—2020年10月福建医科大学孟超肝胆医院收治的119例HBV相关慢加急性肝衰竭患者临床资料，根据患者90 d的生存情况分为死亡组与生存组。抗病毒方案为恩替卡韦或替诺福韦，收集治疗基线时患者ALT、AST、ChE、Alb、CHO、AFP、HBV DNA水平等临床指标及重要并发症的发生情况，并计算MELD评分。计量资料两组间比较采用t检验或Mann-Whitney U检验；计数资料两组间比较采用χ²检验。采用logistic回归分析筛选出HBV相关慢加急性肝衰竭患者90 d预后的影响因素，并构建新的预测模型；通过受试者工作特征曲线(ROC曲线)下面积评估新预测模型对HBV相关慢加急性肝衰竭预后的诊断效能。结果在90 d内，33例患者死亡，病死率为27.7%。生存组与死亡组相比，年龄、ALT、Alb、ChE、MELD评分以及肝性脑病、原发性腹膜炎、肝肾综合征发生率差异均有统计学意义(P值均＜0.05)。logistic回归分析结果显示，基线时肝性脑病(OR=10.404，95%CI：2.522~42.926，P=0.001)、血清Alb水平(OR=0.853，95%CI：0.764~0.952，P=0.005)、MELD评分(OR=1.143，95%CI：1.036~1.261，P=0.008)是影响HBV相关慢加急性肝衰竭患者短期预后的独立预测因素。将这3项指标联合建立新的预测模型，ROC曲线结果显示新模型的曲线下面积为0.833，高于MELD评分的0.672。结论对于HBV相关慢加急性肝衰竭患者90 d预后评估，肝性脑病、Alb水平联合MELD评分建立的新模型较单纯MELD评分具有更好的预测价值。
- 乙型肝炎病毒 /
- 慢加急性肝功能衰竭 /
- 预后 /
- 影响因素分析
Abstract: Objective To investigate the risk factors for short-term prognosis in patients with HBV-related acute-on-chronic liver failure (ACLF). Methods A retrospective analysis was performed for the clinical data of 119 patients with HBV-related ACLF who were admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University from October 2019 to October 2020, and according to their survival status on day 90, they were divided into death group and survival group. The patients were given antiviral therapy with entecavir or tenofovir. Related clinical data were collected, including alanine aminotransferase (ALT), aspartate aminotransferase, cholinesterase (ChE), albumin (Alb), cholesterol, alpha-fetoprotein, and HBV DNA at baseline, as well as the incidence rate of important complications. Model for End-Stage Liver Disease (MELD) score was also calculated. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-squared test was used for comparison of categorical data between two groups; a logistic regression analysis was used to investigate the influencing factors for the 90-day prognosis of patients with HBV-related ACLF and establish a new predictive model; the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency of the new model in predicting the prognosis of HBV-related ACLF. Results Of all patients, 33 died within 90 days, resulting in a mortality rate of 27.7%. There were significant differences between the survival group and the death group in age, ALT, Alb, ChE, MELD score, and incidence rates of hepatic encephalopathy, primary peritonitis, and hepatorenal syndrome (all P < 0.05). The logistic regression analysis showed that baseline hepatic encephalopathy (odds ratio [OR]=10.404, 95% confidence interval [CI]: 2.522-42.926, P=0.001), serum Alb at baseline (OR=0.853, 95%CI: 0.764-0.952, P=0.005), and MELD score at baseline (OR=1.143, 95%CI: 1.036-1.261, P=0.008) were independent predictive factors for the short-term prognosis of patients with HBV-related ACLF. A new predictive model was established based on the combination of these three indices, and the ROC curve analysis showed that this new model had an area under the curve of 0.833, while MELD score had an area under the ROC curve of 0.672. Conclusion As for the evaluation of the 90-day prognosis of patients with HBV-related ACLF, the new prognostic model established based on hepatic encephalopathy, Alb, and MELD score has a better predictive value than MELD score alone.
- Hepatitis B Virus /
- Acute-On-Chronic Liver Failure /
- Prognosis /
- Root Cause Analysis

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图 1 新模型与MELD评分预测HBV相关慢加急性肝衰竭患者短期预后的ROC曲线

下载: 全尺寸图片幻灯片

表 1 两组患者一般资料比较

指标	生存组 (n=86)	死亡组 (n=33)	统计值	P值
男/女(例)	75/11	28/5	χ²=0.114	0.735
年龄(岁)	38.2±11.0	43.4±11.0	t=-2.290	0.023
ALT(U/L)	979.2(619.5~1 174.0)	593.9(457.0~702.0)	Z=-1.980	0.048
AST(U/L)	610.2(346.5~645.0)	569.1(286.0~806.5)	Z=-0.692	0.489
HBV DNA(log₁₀ IU/mL)	5.70(4.51~6.78)	5.60(4.20~7.28)	Z=-0.036	0.972
CHO(mmol/L)	2.8(2.2~3.3)	2.5(2.1~3.4)	Z=-0.309	0.757
AFP(μg/L)	88.5(28.4~181.6)	79.6(50.4~181.0)	Z=-0.351	0.725
Alb(g/L)	29.6±5.6	25.4±4.8	t=3.810	＜0.001
ChE(U/L)	4 099.2±1 517.2	3 118.5±1 122.8	t=3.370	0.001
MELD评分(分)	23.1±4.2	28.1±8.8	t=-3.107	0.004
肝性脑病[例(%)]			χ²=23.424	＜0.001
1期	0	2(6.1)
2期	1(1.2)	7(21.2)
3期	2(2.3)	1(3.0)
4期	0	3(9.1)
原发性腹膜炎[例(%)]	49(57.0)	28(84.8)	χ²=8.112	0.004
肺部感染[例(%)]	12(14.0)	3(9.1)	χ²=0.166	0.684
肝肾综合征[例(%)]	1(1.2)	6(18.2)	χ²=9.592	0.002
上消化道出血[例(%)]	4(4.7)	5(15.2)	χ²=2.409	0.121
恩替卡韦/替诺福韦(例)	61/25	21/12	χ²=0.592	0.442

下载: 导出CSV

表 2 logistic回归分析结果

项目	β值	OR	95%CI	P值
肝性脑病	2.342	10.404	2.522~42.926	0.001
Alb水平	-0.159	0.853	0.764~0.952	0.005
MELD评分	0.133	1.143	1.036~1.261	0.008

下载: 导出CSV

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