血乳酸对HBV相关慢加亚急性肝衰竭患者预后评估  

Blood lactate level and its prognostic value in HBV-associated subacute-on-chronic liver failure

作　　者：陈薇[1] 林苏[1] 陈靖[1] 江家骥[1] 

机构地区：[1]福建医科大学附属第一医院肝病中心,福建福州350005

出　　处：《中国病毒病杂志》2012年第5期370-373,共4页Chinese Journal of Viral Diseases

基　　金：福建省卫生厅青年科研课题资助项目(2012-2-48)

摘　　要：目的探讨静脉血乳酸水平对乙型肝炎病毒(HBV)相关慢加亚急性肝衰竭(SACLF)患者近期预后的评估价值。方法收集2009年10月至2012年2月于福建医科大学附属第一医院肝病中心住院、确诊为HBV相关SACLF的患者,对其入院后3个月的预后进行随访,对生存组和死亡组患者的一般资料、静脉血乳酸及终末期肝病模型(MELD)评分等进行分析,采用受试者工作特征(ROC)曲线评估静脉血乳酸对HBV相关SACLF患者近期预后的预测价值。结果共纳入122例HBV相关SACLF患者,其中生存组67例,男性59例、女性8例,平均年龄(41.54±12.74)岁;死亡组55例,男性43例、女性12例,平均年龄(43.95±12.09)岁,两组年龄和性别差异无统计学意义。生存组静脉血乳酸水平低于死亡组[(2.60±0.99)vs(4.92±3.22)mmol/L](t=5.57,P<0.05)。MELD评分系统和静脉血乳酸水平预测HBV相关SACLF患者近期死亡的曲线下面积分别为0.823和0.803。以2.68mmol/L为最优截断点,静脉血乳酸水平预测HBV相关SACLF患者3个月死亡的灵敏度为80%,特异度为68%。结论 HBV相关SACLF患者的静脉血乳酸水平与其近期预后密切相关,其评估价值稍低于MELD评分系统。Objective To measure the venous blood lactate levels and study its prognostic value in hepatitis B virus（HBV）-associated subacute-on-chronic liver failure（SACLF）.Methods Patients who were admitted to the First Affiliated Hospital of Fujian Midical University from 2009-2012 and diagnosed as HBV-associated SACLF were recruited in this single-center study.The baseline biological parameters such as bilirubin,creatinine,prothrombin,the international normalized ratio for prothrombin time and lactate levels and at admission were detected and 3-month follow-up data were collected after the admission.The predictive value of venous blood lactate for prognosis was analyzed by the receiver operating characteristics（ROC） method.The model end-stage liver disease（MELD） scores of these patients were calculated using the data acquired.Results A total of 122 HBV-associated SACLF patients（102 males,20 females;average age 42.62±12.46） were enrolled in this study.At the end of the 3-month followup,patients were grouped as survivors and non-survivors.The level of venous blood lactate in the non-survivor group is significantly higher than that in the survivor group（4.92 vs 2.60 mmol/L,P〈0.05）.The curve of ROC showed a lactate threshold of 2.68 mmol/L with 80% sensitivity and 68% specificity;and the area under the ROC curve is 0.803,a value lower than the MELD score（0.823）（P〈0.05）.Conclusions The level of venous blood lactate played an imp ortant role in the HBV-associated SACLF,and it might be served as a prognostic predictor for this disease.

关 键 词：乳酸 慢加亚急性肝衰竭 乙型肝炎病毒 

分 类 号：R575.3[医药卫生—消化系统]