血脂指标对乙型肝炎相关慢加急性肝衰竭前期进展的预测价值

官敏; 李嘉妮; 高银杰; 李浩; 王孝平; 汤善宏

doi:10.3969/j.issn.1001-5256.2023.07.009

血脂指标对乙型肝炎相关慢加急性肝衰竭前期进展的预测价值

DOI: 10.3969/j.issn.1001-5256.2023.07.009

官敏^{1, 2},
李嘉妮^{1, 2},
高银杰³,
李浩²,
王孝平⁴,
汤善宏^{1, 2, , ,}

1.
西南交通大学医学院，成都 610031
2.
西部战区总医院消化内科，成都 610083
3.
解放军总医院第五医学中心肝病医学部，北京 100039
4.
遂宁市中心医院消化内科，四川遂宁 629018

基金项目:

四川省卫生健康委员会科研课题 (20PJ180);

中央高校基本科研业务费 (2682021ZTPY022)

伦理学声明：本研究方案于2020年7月9日经西部战区总医院伦理委员会审批，批号：2020ky005。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：官敏参与数据收集，数据分析，文章撰写；李嘉妮、高银杰负责拟定写作思路，论文修改；李浩、王孝平负责数据分析；汤善宏负责拟定写作思路，指导撰写文章与最后定稿。

详细信息

通信作者:
汤善宏，shanhongtang@163.com (ORCID：0000-0001-6652-2942)

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出版历程
- 收稿日期: 2022-10-15
- 录用日期: 2022-11-25
- 出版日期: 2023-07-20

Value of blood lipid parameters in predicting the progression of HBV-related acute-on-chronic pre-liver failure

Min GUAN^{1, 2},
Jiani LI^{1, 2},
Yinjie GAO³,
Hao LI²,
Xiaoping WANG⁴,
Shanhong TANG^{1, 2
, ,
,}

1.
Medical School of Southwest Jiaotong University, Chengdu 610031, China
2.
Department of Gastroenterology, The General hospital of Western Theater Command, Chengdu 610083, China
3.
Department of Liver Disease, The Fifth Medical Center of PLA General Hospital, Beijing 100039, China
4.
Department of Gastroenterology, Suining Central Hospital, Suining, Sichuan 629018, China

Research funding:

Research Project of Sichuan Provincial Health Commission (20PJ180);

Fundamental Research Funds for the Central Universities (2682021ZTPY022)

More Information

Corresponding author: TANG Shanhong, shanhongtang@163.com (ORCID: 0000-0001-6652-2942)

摘要

摘要: 目的分析血脂指标在慢加急性肝衰竭前期(pre-ACLF)和慢加急性肝衰竭(ACLF)组间的差异，并探讨患者进展的危险因素。方法回顾性分析西部战区总医院2012年1月—2020年12月ACLF组(n=118)和pre-ACLF组(n=44)患者的基线年龄、白蛋白、肌酐、血常规、血脂等指标。计量资料服从正态分布的两组间比较采用成组t检验；计量资料不服从正态分布的两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ²检验。通过Logistic二元回归进行多因素分析，筛选独立预测因素。使用受试者工作特征曲线(ROC曲线)比较指标的敏感度和特异度，通过约登指数计算临界值。结果比较两组间年龄、肌酐、白蛋白、TBil、INR、ALT、AST、TG、TC、HDL、LDL、WBC和中性粒细胞计数水平的差异，发现ACLF组患者的TC[2.02(1.56~2.37) mmol/L vs 3.01(2.57~3.66) mmol/L，Z=5.411，P＜0.001]、HDL[0.40(0.25~0.49) mmol/L vs 0.62(0.47~0.75) mmol/L, Z=4.781, P＜0.001]、LDL [1.52(1.22~1.84) mmol/L vs 1.93(1.49~2.36) mmol/L, Z=3.146, P=0.002] 水平显著低于pre-ACLF组，ACLF组患者的TBil[352.13(284.32~ 451.19) μmol/L vs 135.80(112.80~154.68) μmol/L, Z=-9.775, P＜0.001]、INR[1.96(1.71~2.51)vs 1.39(1.33~1.44), Z=-9.776, P＜0.001]、WBC[6.74(5.07~9.19)×10⁹/L vs 5.04(4.13~7.09)×10⁹/L, Z=-3.985, P＜0.001]、中性粒细胞水平[4.67(3.40~7.06)×10⁹/L vs 3.30(2.72~5.01)×10⁹/L, Z=-3.676, P＜0.001]显著高于pre-ACLF组，两组间年龄、肌酐、白蛋白、ALT、AST和TG水平无显著差异(P值均＞0.05)。进一步通过Logistic回归分析发现TC(OR=0.003, 95%CI：0.000~0.068)、LDL(OR=61.901, 95%CI：3.354~1 142.558)、WBC(OR=3.175, 95%CI：1.097~9.185)具有独立预测价值(P值均＜0.05)，ROC结果显示TC的AUC为0.852，LDL敏感度为0.887，TC特异度为0.840。结论血脂指标在pre-ACLF进展到ACLF过程中下降，提示临床医师需要关注pre-ACLF阶段脂质的变化，并及时调整营养方案。
- 慢加急性肝功能衰竭 /
- 胆固醇 /
- 脂蛋白类, LDL
Abstract: Objective To investigate the difference in blood lipid parameters between acute-on-chronic pre-liver failure (pre-ACLF) and acute-on-chronic liver failure (ACLF) and the risk factors for disease progression. Methods A retrospective analysis was performed for the related data of 118 patients with ACLF (ACLF group) and 44 patients with pre-ACLF (pre-ACLF group) who were treated in The General Hospital of Western Theater Command from January 2012 to December 2020, including baseline age, albumin, creatinine, routine blood test results, and blood lipids. The independent samples t-test was used for comparison between normally distributed continuous data; and the Mann-Whitney U test was used for comparison between non-normally distributed continuous data; the chi-square test was used for comparison of categorical data between groups. A binary logistic regression analysis was used for multivariate analysis to identify independent predictive factors. The receiver operating characteristic (ROC) curve was used to compare the sensitivity and specificity of related indicators, and Youden index was used to calculate cut-off values. Results Compared with the pre-ACLF group, the ACLF group had significantly lower levels of total cholesterol (TC)[2.02(1.56-2.37) mmol/L vs 3.01(2.57-3.66) mmol/L, Z=5.411, P < 0.001], high-density lipoprotein [0.40(0.25-0.49) mmol/L vs 0.62(0.47-0.75) mmol/L, Z=4.781, P < 0.001], and low-density lipoprotein (LDL) [1.52(1.22-1.84) mmol/L vs 1.93(1.49-2.36) mmol/L, Z=3.146, P=0.002] and significantly higher levels of total bilirubin [352.13(284.32-451.19) μmol/L vs 135.80(112.80-154.68) μmol/L, Z=-9.775, P < 0.001], international normalized ratio [1.96(1.71-2.51) vs 1.39(1.33-1.44), Z=-9.776, P < 0.001], white blood cell count (WBC) [6.74(5.07-9.19)×10⁹/L vs 5.04(4.13-7.09)×10⁹/L, Z=-3.985, P < 0.001], and neutrophils [4.67(3.40-7.06)×10⁹/L vs 3.30(2.72-5.01)×10⁹/L, Z=-3.676, P < 0.001], while there were no significant differences between the two groups in age, creatinine, albumin, alanine aminotransferase, aspartate aminotransferase, and triglyceride (all P > 0.05). The logistic regression analysis showed that TC (odds ratio [OR]=0.003, 95% confidence interval [CI]: 0.000-0.068, P < 0.05), LDL (OR=61.901, 95%CI: 3.354-1142.558, P < 0.05), and WBC (OR=3.175, 95%CI: 1.097-9.185, P < 0.05) had an independent predictive value, and the ROC analysis showed that the area under the ROC curve of TC was 0.852, the sensitivity of LDL was 0.887, and TC had the best specificity of TC was 0.840. Conclusion There are reductions in blood lipid parameters in the progression from pre-ACLF to ACLF, suggesting that clinicians should pay attention to the changes in lipids in the pre-ACLF stage and adjust the nutritional regimen in a timely manner.
- Acute-On-Chronic Liver Failure /
- Cholesterol /
- Lipoproteins, LDL

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图 1 pre-ACLF组与ACLF组WBC、TC和LDL的ROC曲线

Figure 1. ROC curves of the WBC, TC, and LDL between the pre-ACLF and the ACLF groups

下载: 全尺寸图片幻灯片

表 1 pre-ACLF组和ACLF组患者基线数据比较

Table 1. Comparison of baseline data of patients in the pre-ACLF and ACLF groups

指标	pre-ACLF组(n=44)	ACLF组(n=118)	Z值	P值
年龄(岁)	48.50(36.75~53.75)	46.00(39.75~53.00)	0.228	0.820
肌酐(μmol/L)	72.00(59.00~86.25)	73.50(63.00~87.25)	-0.717	0.473
白蛋白(g/L)	34.16(28.83~37.83)	31.60(29.28~34.92)	1.423	0.155
ALT(U/L)	292.70(64.13~1 025.48)	519.55(141.78~1 208.38)	-1.514	0.130
AST(U/L)	266.70(103.68~730.83)	373.70(163.95~1 047.90)	-1.703	0.089
TC(mmol/L)	3.01(2.57~3.66)	2.02(1.56~2.37)	5.411	＜0.001
TG(mmol/L)	1.25(0.88~1.59)	1.10(0.72~1.42)	1.615	0.106
HDL(mmol/L)	0.62(0.47~0.75)	0.40(0.25~0.49)	4.781	＜0.001
LDL(mmol/L)	1.93(1.49~2.36)	1.52(1.22~1.84)	3.146	0.002
WBC(×10⁹/L)	5.04(4.13~7.09)	6.74(5.07~9.19)	-3.985	＜0.001
中性粒细胞计数(×10⁹/L)	3.30(2.72~5.01)	4.67(3.40~7.06)	-3.676	＜0.001
TBil(μmol/L)	135.80(112.80~154.68)	352.13(284.32~451.19)	-9.775	＜0.001
INR	1.39(1.33~1.44)	1.96(1.71~2.51)	-9.776	＜0.001

下载: 导出CSV

表 2 pre-ACLF组和ACLF相关指标的Logistic回归结果

Table 2. Results of logistic regression of correlation indicators between pre-ACLF and ACLF groups

变量	单因素分析			多因素分析
变量	OR	95%CI	P值	OR	95%CI	P值
TC(mmol/L)	0.114	0.046~0.284	＜0.001	0.003	0.000~0.068	＜0.001
HDL(mmol/L)	0.010	0.001~0.088	＜0.001	27.200	0.220~3 360.146	0.179
LDL(mmol/L)	0.198	0.079~0.495	0.001	61.901	3.354~1 142.558	0.006
WBC(×10⁹/L)	1.387	1.163~1.654	＜0.001	3.175	1.097~9.185	0.033
中性粒细胞计数(×10⁹/L)	1.399	1.143~1.714	0.001	0.407	0.130~1.276	0.123
白蛋白(g/L)	0.939	0.880~1.002	0.059
肌酐(μmol/L)	1.002	0.997~1.008	0.403

下载: 导出CSV

表 3 TC、LDL和WBC的预测效能

Table 3. Predictive performances of TC, LDL, and WBC

参数	P值	AUC	临界值	敏感度	特异度	95%CI
TC	＜0.001	0.852	2.455 mmol/L	0.794	0.840	0.760~0.944
LDL	0.002	0.701	2.060 mmol/L	0.887	0.480	0.574~0.828
WBC	0.001	0.718	5.885×10⁹/L	0.629	0.760	0.604~0.832

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