摘要
背景非选择性β受体阻滞剂(non-selectiveβ-blockers,NSBBs)是肝硬化背景下门静脉高压症的主要治疗方法,肝硬化患者慢加急性肝衰竭的研究表明,应用NSBBs后慢加急性肝衰竭分级、白细胞计数以及血浆C反应蛋白(C reactive protein,CRP)水平降低,进而提出NSBBs具有抗炎作用.目的基于竞争风险模型分析NSBBs对晚期慢性肝病炎症因子及预后的影响.方法收集本院使用NSBBs治疗的晚期慢性肝病患者319例,比较治疗前后肝静脉压力梯度(hepatic venous pressure gradient,HVPG)及炎症因子水平变化,采用竞争风险模型分析治疗后白细胞计数(white blood cell count,WBC)变化对失代偿率及肝相关病死率的影响.结果NSBBs治疗后HVPG、WBC及C反应蛋白比治疗前明显降低(P<0.05).将肝移植和非肝相关病死设为竞争风险,发现WBC应答(下降≥20%)可降低基线失代偿患者的进一步失代偿风险(HR=0.708);WBC应答是无肝移植者肝相关生存的独立预测因子(HR=0.582);WBC应答增加了肝移植者肝相关病死风险(HR=1.759).结论NSBBs有助于改善晚期慢性肝病的炎症反应,且在Child-Pugh C级患者中表现更明显,WBC下降≥20%可降低进一步失代偿及无肝移植者肝相关病死风险.
BACKGROUND Non-selective β-blockers(NSBBs)are the main treatment for portal hypertension in the context of liver cirrhosis.Studies of acute-on-chronic liver failure in patients with liver cirrhosis have shown that the application of NSBBs decreases the grades of liver failure,white blood cell count(WBC),and plasma C reactive protein(CRP)levels,suggesting that NSBBs have anti-inflammatory effects.AIM To determine the effects of NSBBs on inflammatory factors and prognosis in advanced chronic liver disease based on a competitive risk model.METHODS A total of 319 patients with advanced chronic liver disease treated with NSBBs at our hospital were included.The changes of hepatic venous pressure gradient(HVPG)and inflammatory factor levels before and after treatment were compared.A competitive risk model was used to analyze the effect of changes in WBC after treatment on the decompensation rate and liver-related mortality.RESULTS HVPG,WBC,and CRP after NSBBs treatment were significantly lower than the values before treatment(P<0.05).Taking liver transplantation and non-liver-related deaths as competitive risks,it was found that WBC response(decreased by≥20%)can reduce the risk of further decompensation in patients with baseline decompensation(hazard ratio[HR]=0.708).WBC response was identified to be an independent predictor of liver-related survival in patients without liver transplantation(HR=0.582).WBC response increased the risk of liver-related death in liver transplant patients(HR=1.759).CONCLUSION NSBBs help to improve the inflammatory response in advanced chronic liver disease,which is more obvious in Child-Pugh C patients.A decrease of ≥20% in WBC can reduce the risk of liver-related death in patients with further decompensation and without liver transplantation.
作者
王艳娇
朱雅碧
魏雯佳
Yan-Jiao Wang;Ya-Bi Zhu;Wen-Jia Wei(Department of Gastroenterology,The People’s Hospital of Lishui City,Lishui 323000,Zhejiang Province,China;Department of Hepatology,The People’s Hospital of Lishui City,Lishui 323000,Zhejiang Province,China)
出处
《世界华人消化杂志》
CAS
2021年第19期1110-1117,共8页
World Chinese Journal of Digestology
关键词
竞争风险模型
非选择性Β受体阻滞剂
晚期慢性肝病
炎症因子
Competitive risk model
Non-selective β-blockers
Advanced chronic liver disease
Inflammatory factors
