乙型肝炎病毒相关慢加急性肝衰竭患者近期预后危险因素的研究  

Risk factors for short-term outcome of patients with HBV-related acute-on-chronic liver failure

作　　者：李晨[1,2] 吕飒[2] 朱冰[2] 万志红[2] 刘婉姝[2] 郭丽 游绍莉[2] 辛绍杰[1,2] 

机构地区：[1]解放军医学院,北京100853 [2]解放军第302医院肝衰竭诊疗与研究中心,北京100039 [3]解放军第61785部队门诊部,北京100075

出　　处：《中华肝脏病杂志》2016年第3期207-213,共7页Chinese Journal of Hepatology

基　　金：解放军第302医院创新课题（YNKT2014008）;“十二五”国家传染病科技重大专项（2012ZX10002004-005）

摘　　要：目的 探讨影响HBV相关慢加急性肝衰竭（ACLF）患者近期预后的危险因素,并建立预测近期预后的风险模型. 方法 对北京解放军第302医院2010年1月至2014年1月间收治的338例HBV相关ACLF患者进行前瞻性临床随访,用多因素logistic回归分析,得出影响患者近期（12周）预后的危险因素,建立logistic回归方程预测模型,并对所得模型的预测价值进行评估. 结果 多因素logistic回归分析结果显示年龄、乙型肝炎家族史、肝性脑病（HE）、肝肾综合征（HRS）、白细胞计数（WBC）、血小板（PLT）、国际标准化比值（INR）、总胆红素（TBil）、总胆汁酸（TBA）、胆碱酯酶（CHE）、血肌酐（CRE）、血清钠（Na）、HBV DNA及HBeAg是预测该类患者近期预后的独立危险因素.logistic （p）=-4.466＋1.192×年龄＋1.631×乙型肝炎家族＋1.091×HE＋1.631×HRS＋1.208×WBC-1.487×PLT＋1.092×INR＋1.446×TBil＋1.608×TBA-1.101×CHE＋1.279×CRE-1.713×Na＋1.032×HBV DNA＋0.833×HBeAg.所得预测近期预后模型ROC曲线下面积为0.930,Cut-off值为3.16,敏感度为0.860,特异度为0.871,随方程分值增加,患者病死率呈逐渐上升趋势. 结论 年龄、乙型肝炎家族史、HE、HRS、WBC、PLT、INR、TBil、TBA、CHE、CRE、Na、HBV DNA及HBeAg是预测HBV相关ACLF患者近期预后的独立危险因素,根据独立危险因素构建的近期预后预测模型对指导治疗具有较好的临床价值.Objective To investigate the risk factors for the short-term outcome of patients with hepatitis B virus （HBV）-related acute-on-chronic liver failure （ACLF）,and to establish a risk model for predicting the shortterm outcome of these patients.Methods A total of 338 patients with HBV-related ACLF who were admitted to 30 Lod hospital of PLA hospital from January 2010 to January 2014 were enrolled,and a prospective clinical follow-up was performed for them.Multivariate logistic regression was used to determine the risk factors for short-term （12 weeks） outcome,the predictive model with logistic regression equation was established,and the predictive value of this model was evaluated.Results The multivariate logistic regression analysis showed that age,a family history of hepatitis B,hepatic encephalopathy （HE）,hepatorenal syndrome （HRS）,white blood cell （WBC）,platelet （PLT）,international normalized ratio （INR）,total bilirubin （TBil）,total bile acid （TBA）,creatinine,Na,HBV DNA,and HBeAg were the independent risk factors for the short-term outcome of these patients.Logistic（p） =-4.466 ＋ 1.192 age ＋ 1.631 family history of hepatitis B ＋ 1.091 HE ＋ 1.631 HRS ＋ 1.208 WBC-1.487 PLT ＋ 1.092 INR ＋ 1.446 TBil ＋ 1.608 TBA-1.101 CHE ＋ 1.279 CRE-1.713 Na ＋ 1.032 HBV DNA ＋ 0.833 HBeAg.The area under the receiver operating characteristic curve of the model for the prediction of short-term outcome was 0.930,the cut-off value was 3.16,the sensitivity was 0.860,and the specificity was 0.871.With the increasing scores of the equation,the mortality of patients tended to increase gradually.Conclusion Age,a family history of hepatitis B,HE,HRS,WBC,PLT,INR,TBil,TBA,CHE,CRE,Na,HBV DNA,and HBeAg are the independent risk factors for the short-term outcome of patients with HBV-related ACLF.The model for predicting short-term outcome established on the basis of independent risk factors has a better clinical value in guiding clinical therapy.

关 键 词：肝炎病毒 乙型 肝功能衰竭 预后 危险因素 

分 类 号：R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学]