摘要
目的 本研究探讨常用血液学指标的动态变化对乙型肝炎病毒相关性慢加急性肝衰竭(HBV-ACLF)预后的预测价值.方法 采用回顾性病例对照研究,纳入2018年1月-2022年10月于上海交通大学医学院附属瑞金医院确诊和治疗的HBV-ACLF患者137例.根据患者入院后28 d是否生存,将其分为死亡组(69例)与生存组(68例).收集患者基线与入院后14 d的生物化学指标、血常规、CRP、降钙素原(PCT)等指标,计算并比较入院后14 d的各项指标与基线的差值.采用单因素和多因素分析影响HBV-ACLF患者预后的因素,并绘制ROC曲线评估其预测价值.结果 死亡组患者年龄显著高于生存组(P＜0.05).入院后14 d,死亡组患者总胆红素(TBil)、血白细胞计数(WBC)、中性粒细胞百分比(NE％)、CRP、PCT、血清肌酐(sCr)和INR的增高值均显著大于生存组患者(P值均＜0.001).多因素分析结果显示,血清TBil、WBC、NE％、sCr、PCT和INR增高是影响HBV-ACLF预后的独立危险因素(P值均＜0.05).绘制ROC曲线结果显示患者入院后14 d血清TBil、WBC、NE％、sCr、PCT、INR较基线增高的程度对患者预后有较高的预测价值(P值均＜0.001).结论 患者入院后14 d的血清TBil、WBC、NE％、sCr、PCT、INR较基线增高程度对HBV-ACLF的预后有一定的预测价值.
Abstract
Objective To explore the prognostic factors of hepatitis B virus related acute-on-chronic liver failure(HBV-ACLF)affected by dynamic blood indicators.Methods A total of 137 patients with HBV-ACLF diagnosed and treated in Shanghai Ruijin Hospital from January 2018 to October 2022 were enrolled in this retrospective case-control study.The patients were categorized into death group(69 patients)and survival group(68 patients)based on whether they survived 28 d after admission.The baseline and 14-day-after-admission biochemical indicators,blood routine,C-reactive protein(CRP)and procalcitonin(PCT)were collected and compared.Univariate and multivariate analyses were performed to assess the influencing factors of prognosis in patients with HBV-ACLF.Receiver operator characteristic(ROC)curve was drawn and the predictive value of these factors were evaluated.Results The patients in the death group were significantly older than those in the survival group(P＜0.05).On day 14 after admission,the increased values of total bilirubin(Tbil),white blood cell count(WBC),neutrophilic granulocyte percentage(NE％),CRP,PCT,serum creatinine(sCr)and international normalized ratio(INR)in the death group were significantly greater than those in the survival group(all P＜0.001).The results of multivariate analysis showed that increased serum Tbil,WBC,NE％,sCr,PCT and INR were independent risk factors for HBV-ACLF(all P＜0.05).The increased values of serum Tbil,WBC,NE％,sCr,PCT,and INR assessed by AUROC using ROC curves on day 14 after admission had a high predictive value for prognosis compared with baseline(all P＜0.001).Conclusion The increases of serum Tbil,WBC,NE％,sCr,PCT,and INR on day 14 after admission had certain predictive value for the prognosis of patients with HBV-ACLF.
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