血清游离三甲碘状腺原氨酸水平预测HBV相关慢加急性肝衰竭患者预后的价值分析

张剑; 陈煜; 段钟平

doi:10.3969/j.issn.1001-5256.2022.01.012

血清游离三甲碘状腺原氨酸水平预测HBV相关慢加急性肝衰竭患者预后的价值分析

DOI: 10.3969/j.issn.1001-5256.2022.01.012

首都医科大学附属北京佑安医院疑难肝病及人工肝中心，北京 100069

基金项目:

国家科技重大专项“艾滋病和病毒性肝炎等重大传染病防治” (2017ZX10302201-004-002)

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：张剑负责课题设计，收集数据，资料分析，撰写论文；陈煜参与修改论文；段钟平负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
段钟平，duan2517@163.com

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出版历程
- 收稿日期: 2021-06-26
- 出版日期: 2022-01-20

Value of serum free triiodothyronine level in predicting the prognosis of patients with HBV-related acute-on-chronic liver failure

Difficult & Complicated Liver Diseases and Artificial Liver Center, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China

Research funding:

National Science and Technology Key Project on "Major Infectious Disease such as HIV/AIDS, Viral Hepatitis Prevention and Treatment" (2017ZX10302201-004-002)

摘要

摘要: 目的探讨血清游离三甲碘状腺原氨酸(FT3)水平对HBV相关慢加急性肝衰竭(HBV-ACLF)患者90 d预后的预测价值。方法收集2018年9月—2020年1月在首都医科大学附属北京佑安医院住院的122例HBV-ACLF患者的临床资料，根据确诊后90 d预后分为生存组(n=77)和死亡组(n=45)。采用ELISA法测定血清FT3水平，比较FT3水平在两组间差异，应用logistic回归分析探索影响预后的危险因素并建立FT3相关预测模型，采用预测概率值的ROC曲线下面积(AUC)评估预测模型的区分度，采用线性回归分析评估校准度。采用AUC比较模型与MELD评分预测预后价值的差异。符合正态分布的计量资料两组间比较采用t检验；非正态分布的计量资料两组间比较采用Mann-Whitney U检验；计数资料两组间比较采用χ²检验；采用logistic回归分析预后影响因素。结果死亡组FT3显著低于生存组[(2.27±0.38) pmol/L vs (2.69±0.55) pmol/L，t=4.526, P＜0.001], FT3(OR=0.534，95%CI：0.300~0.950，P=0.013)是影响预后的独立保护因素；年龄(OR=1.047，95%CI：1.013~1.082，P=0.007)、TBil(OR=1.096，95%CI：1.059~1.134，P＜0.001)、INR(OR=1.101，95%CI：1.029~1.178，P＜0.005)、Cr(OR=4.583，95%CI：2.102~7.992，P＜0.001)是独立危险因素。FT3相关预测模型区分度的AUC为0.869(95%CI：0.831~0.907)，P＜0.001；校准能力R²=0.340，P=0.268。FT3相关公式预测预后的价值显著好于MELD评分(P＜0.05)。结论 FT3是HBV-ACLF患者90 d预后的独立影响因素，其与年龄、TBil、INR、Cr联合建立的FT3相关预测模型对患者90 d预后评估具有较好的预测价值。
- 慢加急性肝功能衰竭 /
- 三碘甲状腺原氨酸 /
- 预后
Abstract: Objective To investigate the value of serum free triiodothyronine (FT3) level in predicting the 90-day prognosis of patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF). Methods Related clinical data were collected from 122 patients with HBV-ACLF who were hospitalized in Beijing YouAn Hospital, Capital Medical University, from September 2018 to January 2020, and according to their prognosis on day 90 after confirmed diagnosis, they were divided into survival group with 77 patients and death group with 45 patients. ELISA was used to measure the serum level of FT3, which was then compared between the two groups; a logistic regression analysis was used to investigate the risk factors for prognosis and establish an FT3-related predictive model; the area under the receiver operating characteristic (ROC) curve (AUC) of the predicted probability value was used to evaluate the discriminatory ability of the predictive model, and a linear regression analysis was used to evaluate calibration degree. AUC was used to compare the predictive value of this model and Model for End-Stage Liver Disease (MELD) score. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups; univariate and multivariate logistic regression analyses were used to investigate the influencing factors for prognosis. Results The death group had a significantly lower serum level of FT3 than the survival group (2.27±0.38 pmol/L vs 2.69±0.55 pmol/L, t=4.526, P < 0.001). FT3 (odds ratio [OR]=0.534, 95% confidence interval [CI]: 0.300-0.950, P=0.013) was an independent protective factor against poor prognosis, while age (OR=1.047, 95%CI: 1.013-1.082, P=0.007), total bilirubin (TBil) (OR=1.096, 95%CI: 1.059-1.134, P < 0.001), international normalized ratio (INR) (OR=1.101, 95%CI: 1.029-1.178, P < 0.005), and creatinine (Cr) (OR=4.583, 95%CI: 2.102-7.992, P < 0.001) were independent risk factors. In terms of discriminatory ability, the FT3-related predictive model had an AUC of 0.869 (95%CI: 0.831-0.907, P < 0.001), and for calibration ability, R²=0.340, P=0.268. The FT3-related formula was better than MELD score in predicting prognosis (P < 0.05). Conclusion FT3 is an independent influencing factor for 90-day prognosis in patients with HBV-ACLF, and the FT3-related predictive model based on FT3 in combination with age, TBil, INR, and Cr has a good value in predicting 90-day prognosis.
- Acute-On-Chronic Liver Failure /
- Triiodothyronine /
- Prognosis

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图 1 FT3相关公式得分预测累积概率与实测累积概率

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图 2 HBV-ACLF患者90 d预后的ROC曲线

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表 1 HBV-ACLF患者入院情况

指标	生存组(n=77)	死亡组(n=45)	统计值	P值
年龄(岁)	44.65±10.58	48.85±10.13	t=4.551	＜0.001
男/女(例)	65/12	35/10	χ²=1.301	0.254
慢性乙型肝炎/肝硬化(例)	31/46	14/31	χ²=7.345	0.007
ALT(U/L)	285.81(112.27~521.15)	153.65(92.17~3 756.18)	U=1.179	0.230
AST(U/L)	153.50(92.95~434.76)	136.9(86.1~305.95)	U=1.016	0.618
TBil(mg/dL)	19.26±8.59	28.31±8.97	t=9.375	＜0.001
INR	2.73±1.27	5.23±1.86	t=4.859	＜0.001
Cr(mg/dL)	0.72±0.25	1.54±0.56	t=7.914	＜0.001
Alb(g/L)	32.34±3.95	31.72±4.19	t=-1.295	0.196
Na(mmol/L)	136.22±3.67	133.65±6.91	t=-4.514	＜0.001
WBC(×10⁹/L)	7.40(5.01~9.57)	9.19(6.04~10.56)	U=8.573	0.001
MELD	26.48±5.19	33.68±4.87	t=11.950	＜0.001

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表 2 预后危险因素的单因素logistic回归分析

因素	β值	Wald值	OR值	95%CI	P值
年龄	0.054	18.305	1.055	1.030~1.082	＜0.001
性别	0.500	1.279	1.148	0.693~2.917	0.258
慢性乙型肝炎/肝硬化	-0.689	7.213	0.502	0.303~0.830	0.007
TBil	0.114	56.431	1.121	1.088~1.165	＜0.001
INR	0.193	5.594	1.213	1.034~1.423	0.018
Alb	-0.038	1.669	0.962	0.908~1.020	0.196
Cr	2.226	28.933	9.259	4.115~14.834	＜0.001
Na	-0.108	17.818	0.898	0.854~0.944	＜0.001
FT3	-0.982	18.478	0.375	0.240~0.586	＜0.001
WBC	0.070	9.919	1.073	1.027~1.120	0.002

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表 3 预后危险因素的多因素logistic回归分析

因素	β值	Wald值	OR值	95%CI	P值
年龄	0.046	7.330	1.047	1.013~1.082	0.007
慢性乙型肝炎/肝硬化	-0.595	2.922	0.552	0.279~1.091	0.097
TBil	0.092	27.979	1.096	1.059~1.134	＜0.001
INR	0.096	7.797	1.101	1.029~1.178	0.005
Cr	1.522	14.649	4.583	2.102~7.992	＜0.001
Na	-0.043	1.991	0.958	0.902~1.017	0.158
FT3	-0.627	4.559	0.534	0.300~0.950	0.013
WBC	0.011	0.159	1.011	0.956~1.070	0.690

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