摘要
目的探讨中性粒细胞/淋巴细胞比值(NLR)和终末期肝病联合血清钠(MELD-Na)评分在乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者短期预后评估中的应用价值。方法回顾性分析2019年1月至2021年12月杭州市西溪医院连续收治的234例HBV-ACLF患者的临床资料,其中男性194例、女性40例,年龄23~85岁。入院后12周内(短期)预后差者93例(预后差组)、临床治愈与临床好转者141例(生存组)。比较两组一般情况、外周血常规及NLR、病毒检测及肝功能各项指标等;采用单因素及多因素logistic回归分析影响HBV-ACLF患者短期预后的相关因素,绘制受试者工作特征(ROC)曲线、计算其曲线下面积;建立NLR与MELD-Na评分二者联合的logistics回归模型,观察其对HBV-ACLF患者预后判断的价值。结果生存组与预后差组患者年龄[(48.7±11.9)和(52.5±9.9)岁,t=-2.59,P=0.011]、男性比例[78.0%(110/141)和90.3%(84/93),χ^(2)=5.99,P=0.014]、总胆红素[202.9(141.2,287.6)和320.0(224.4,400.0)μmol/L,Z=-5.14,P<0.001]、血肌酐[71.0(59.0,78.0)和81.0(64.0,111.0)μmol/L,Z=-3.98,P<0.001]、国际标准化比值[1.66(1.52,1.86)和1.91(1.66,2.27),Z=-5.46,P<0.001]、外周血白细胞计数[5.16(3.99,6.95)×10^(9)/L和6.57(4.83,8.30)×10^(9)/L,Z=-4.14,P=0.001]、NLR[2.77(2.02,3.55)和5.48(3.44,8.53),Z=-8.48,P<0.001]、终末期肝病评分[22.0(20.0,24.0)和26.0(24.0,29.0),Z=-9.22,P<0.001]、MELD-Na评分[22.8(20.0,25.6)和29.0(25.0,36.0),Z=-9.16,P<0.001]、肝硬化比例[77.3%(109/141)和88.2%(82/93),χ^(2)=4.41,P=0.036]、肝肾综合征比例[2.8%(4/141)和12.9%(12/93)例,χ^(2)=8.91,P=0.003]及人工肝治疗比例[14.9%(21/141)和25.8%(24/93)例,χ^(2)=4.30,P=0.038]差异有统计学意义。logistic回归分析显示NLR(OR=3.76,95%CI:2.10~6.74,P<0.001)和MELD-Na评分(OR=2.24,95%CI:1.17~4.29,P=0.015)是影响HBV-ACLF患者入院后12周预后的独立危险因素。NLR和MELD-Na评分对HBV-ACLF患者短期预后预测的ROC曲线下面积分别为0.792和0.822,二者联合logistic预测模型预测的ROC曲线下面积为0.858,预测价值优于单独应用NLR(Z=-3.04,P=0.001)或MELD-Na评分(Z=-2.16,P=0.031)的预测价值。根据二者联合logistic预测模型的最佳截断值0.04,将患者分为≥0.04组和<0.04组,两组患者的生存率分别为78.5%(124/158)和22.4%(17/76),≥0.04组生存率显著高于<0.04组(χ^(2)=67.47,P<0.001)。结论NLR和MELD-Na评分是影响HBV-ACLF患者短期预后的独立危险因素,二者联合的logistic回归模型的判断效能高于单独应用。
Objective To evaluate neutrophil/lymphocyte ratio(NLR)and the model for end-stage liver disease-sodium(MELD-Na)score in predicting short-term prognosis of patients with HBV-related acute-on-chronic liver failure(HBV-ACLF).Methods A total of 234 consecutive HBV-ACLF patients(194 males and 40 females,aged 23-85 years)admitted to Hangzhou Xixi Hospital from January 2019 to December 2021 were enrolled.According to the 12-week clinical outcomes,patients were divided into good prognosis group(n=141)and poor prognosis group(n=93).Univariate and multivariate Logistic regression were performed to identify independent risk factors for poor prognosis of HBV-ACLF patients.Receiver operating characteristics(ROC)curve was applied to evaluate the accuracy of risk factors in predicting short-term prognosis of HBV-ACLF patients.Results The age[(48.7±11.9)vs.(52.5±9.9)years old,t=-2.59,P=0.011],proportion of males[78.0%(110/141)vs.90.3%(84/93),χ^(2)=5.99,P=0.014],total bilirubin[202.9(141.2,287.6)vs.320.0(224.4,400.0)μmol/L,Z=-5.14,P<0.001],creatinine[71.0(59.0,78.0)vs.81.0(64.0,111.0)μmol/L,Z=-3.98,P<0.001],international normalized ratio[1.66(1.52,1.86)vs.1.91(1.66,2.27),Z=-5.46,P<0.001],leukocyte count[5.16(3.99,6.95)×10^(9)/L vs.6.57(4.83,8.30)×10^(9)/L,Z=-4.14,P=0.001],NLR[2.77(2.02,3.55)vs.5.48(3.44,8.53),Z=-8.48,P<0.001],MELD score[22.0(20.0,24.0)vs.26.0(24.0,29.0),Z=-9.22,P<0.001],MELD-Na score[22.8(20.0,25.6)vs.29.0(25.0,36.0),Z=-9.16,P<0.001],liver cirrhosis[77.3%(109/141)vs.88.2%(82/93),χ^(2)=4.41,P=0.036],hepatorenal syndrome[4/141(2.8%)vs.12/93(12.9%),χ^(2)=8.91,P=0.003]and the proportion of artificial liver treatment[21/141(14.9%)vs.24/93(25.8%),χ^(2)=4.30,P=0.038]were significantly elevated in poor prognosis group compared with survival group.Logistic regression analysis showed that NLR(OR=3.76,95%CI:2.10-6.74,P<0.001)and MELD-Na score(OR=2.24,95%CI:1.17-4.29,P=0.015)were independent risk factors for poor short-term prognosis of HBV-ACLF patients.The area under the ROC curve(AUC)of NLR,and MELD-Na for the short-term prognosis of HBV-ACLF patients was 0.792 and 0.822,respectively.The AUC of the combination of NLR with MELD-Na was 0.858,which was significantly higher than that of NLR(Z=-3.04,P=0.001)or MELD-Na score(Z=-2.16,P=0.031)alone.Based on the cut-off value of the combined model,patients were classified into high combined model score(≥0.04)group and low combined model score(<0.04)group,the survival rate of the high group was significantly higher than that of the low group(χ^(2)=67.47,P<0.001).Conclusions NLR and MELD-Na score are independent risk factors of the short-term prognosis of HBV-ACLF patients.The combination of NLR and MELD-Na score will be beneficial to predict the short-term prognosis of HBV-ACLF patients.
作者
刘斐
傅晓晴
刘春涛
武瑞
华乐
刘寿荣
Liu Fei;Fu Xiaoqing;Liu Chuntao;Wu Rui;Hua Le;Liu Shourong(Department of Severe Liver Disease,Hangzhou Xixi Hospital Affiliated to Zhejiang University School of Medicine,Hangzhou 310023,China;Statistics Office of Hangzhou Xixi Hospital Affiliated to Zhejiang University School of Medicine,Hangzhou 310023,China)
出处
《中华全科医师杂志》
2023年第1期62-68,共7页
Chinese Journal of General Practitioners
基金
浙江省医药卫生科技计划项目(2022KY276)
杭州市医药卫生科技计划项目(0020190542)。
