乙肝相关慢加急性肝衰竭患者临床短期预后因素的分析

黄敏; 李冬冬; 刘传苗

doi:10.16766/j.cnki.issn.1674-4152.002227

乙肝相关慢加急性肝衰竭患者临床短期预后因素的分析

doi: 10.16766/j.cnki.issn.1674-4152.002227

蚌埠医学院第一附属医院感染科，安徽蚌埠 233004

基金项目:

安徽高校自然科学研究项目 KJ2017A247

详细信息

通讯作者:
刘传苗, E-mail: liuchuanmiao119@sina.com

中图分类号: R512.62 R575.3
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- PDF下载量: 8
- 被引次数: 0
出版历程
- 收稿日期: 2021-07-28
- 网络出版日期: 2022-03-02

Analysis of clinical short-term prognostic factors in patients with hepatitis B-related acute-on-chronic liver failure

Department of Infection, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨终末期肝病模型(MELD)评分、总胆红素、白蛋白、国际标准化比值、凝血酶原活动度与乙肝相关的慢加急性肝衰竭(ACLF)患者短期预后的关系。方法收集2018年1月—2020年12月蚌埠医学院第一附属医院感染性疾病科住院的乙肝相关ACLF患者124例，收集患者肝功能、凝血功能等相关指标数据，注意患者是否行人工肝治疗，并进行MELD评分。根据患者入院后90 d是否存活，分为存活组(68例)和死亡组(56例)。分别比较2组患者的MELD评分、总胆红素、白蛋白、国际标准化比值、凝血酶原活动度、年龄，使用logistic回归分析研究各项指标与HBV-ACLF患者预后的关系。结果存活组患者的MELD评分、国际标准化比值、总胆红素、年龄分别为(22.66±4.69)分、1.72±0.42、(281.09±94.21)μmol/L、(40.54±7.39)岁，均显著低于死亡组[(31.38±5.39)分、2.64±0.61、(360.54±130.97)μmol/L、(45.73±12.72)岁]，差异均有统计学意义(均P＜0.05)；存活组患者白蛋白、凝血酶原活动度分别为(31.21±3.83)g/L、(35.95±11.82)%，均显著高于死亡组患者[(28.43±4.46)g/L、(29.54±12.10)%]，差异均有统计学意义(均P＜0.05)。Logistic回归分析显示，MELD评分高、高水平TBil、高水平INR、年龄大是ACLF患者的独立危险因素，高水平Alb、高水平PTA是ACLF患者的保护因素。结论 MELD评分、总胆红素、白蛋白、国际标准化比值、凝血酶原活动度均可作为预测ACLF患者短期预后的相关指标。
- 终末期肝病模型评分 /
- 总胆红素 /
- 白蛋白 /
- 国际标准化比值 /
- 凝血酶原活动度 /
- 乙肝 /
- 慢加急性肝衰竭 /
- 预后
Abstract: Objective To explore the relationship between the model for end-stage liver disease (MELD) score, total bilirubin, albumin, international normalized ratio and prothrombin activity and the prognosis in patients with hepatitis B-related acute-on-chronic liver failure (ACLF). Methods A total of 124 patients with hepatitis B-related ACLF who were admitted from January 2018 to December 2020 were collected from the Department of Infection, the First Affiliated Hospital of Bengbu Medical University. The relevant indexes of liver function and coagulation function were collected, and whether the patients were treated with artificial liver or not, and the MELD score was also evaluated. On the basis of the clinical outcome after 90-day admission, the patients were divided into the survival group and death group. Data of MELD score, total bilirubin, albumin, international normalized ratio and prothrombin activity were compared between the two groups. Logistic regression analysis was used to study the relationship between various indexes and the prognosis of HBV-ACLF patients. Results The MELD score, the international normalized ratio and the total and the ages bilirubin in the survival group were (22.66±4.69) scores, 1.72±0.42 and (281.09±94.21) μmol/L and (40.54±7.39) ages, respectively, which were significantly lower than those in the death group [(31.38±5.39) scores, 2.64±0.61 and (360.54±130.97) μmol/L and (45.73±12.72) ages], all of the differences were statistically significant (all P < 0.05). The albumin and prothrombin activity in the survival group were (31.21±3.83) g/L and (35.95±11.82)%, respectively, which were significantly higher than those in the death group [(28.43±4.46) g/L and (29.54±12.10)%)], all of the differences were statistically significant (all P < 0.05). Logistic regression analysis showed that the higher MELD score, the higher level of TBIL, the higher level of INR and the elder age were considered as independent risk factors of ACLF patients, and albumin and prothrombin activity were considered as protective factors of ACLF patients. Conclusion The MELD score, total bilirubin, albumin, international normalized ratio and prothrombin activity can be used as prognostic predictors in sepsis patients.
- Model for end-stage liver disease score /
- Total bilirubin /
- Albumin /
- International normalized ratio /
- Prothrombin activity /
- Hepatitis B virus /
- Acute-on-chronic liver failure /
- Prognosis

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表 1 2组乙肝相关慢加急性肝衰竭患者各指标比较(x±s)

组别	例数	MELD评分(分)	TBIL(μmol/L)	ALB(g/L)	PTA(%)	INR	年龄(岁)
存活组	68	22.66±4.69	281.09±94.21	31.21±3.83	35.95±11.82	1.72±0.42	40.54±7.39
死亡组	56	31.38±5.39	360.54±130.97	28.43±4.46	29.54±12.10	2.64±0.61	45.73±12.72
t值		-9.628	-3.801	3.727	2.975	-9.633	-2.701
P值		< 0.001	< 0.001	< 0.001	0.004	< 0.001	0.008

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表 2 预后相关因素的logistic回归分析

项目	B	SE	Wald χ²	P值	OR值	95% CI
MELD评分	0.454	0.080	32.323	< 0.001	1.575	1.418~1.732
TBIL	0.006	0.002	12.602	< 0.001	1.006	1.002~1.010
ALB	-0.164	0.049	11.464	0.001	0.849	0.753~0.945
PTA	-0.046	0.016	7.873	0.005	0.955	0.924~0.986
INR	3.223	0.552	34.055	< 0.001	25.114	24.032~26.196
年龄	0.052	0.019	7.052	0.008	1.053	1.014~1.094

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