平均血小板体积对HBV相关慢加急性肝衰竭预后的评估价值  

Value of mean platelet volume in evaluating the prognosis of hepatitis B virus-associated acute-on-chronic liver failure

作　　者：徐英[1] 黄小平[1] 陈丽[1] 顾静[1] 王艳[1] 甘建和[1] XU Ying;HUANG Xiaoping;CHEN Li;GU Jing;WANG Yan;GAN Jianhe(Intensive Care Unit,Department of Infectious Diseases,The First Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215000,China)

机构地区：[1]苏州大学附属第一医院感染科ICU,江苏苏州215000

出　　处：《临床肝胆病杂志》2020年第10期2199-2202,共4页Journal of Clinical Hepatology

基　　金：国家科技部“十三五”重大专项(2017ZX10203201002-002)。

摘　　要：目的探讨平均血小板体积(MPV)与HBV相关慢加急性肝衰竭(HBV-ACLF)预后的关系及其价值。方法选取苏州大学附属第一医院感染科2015年1月-2019年12月收治的乙型肝炎肝硬化37例,HBV-ACLF患者44例,慢性乙型肝炎27例,同期健康体检人员24例,回顾性分析其临床资料,包括性别、年龄,TBil、肌酐(Cr)、尿素氮(BUN)、Alb,血氨(NH3),血常规,MELD评分,凝血常规。根据预后的不同,HBV-ACLF分为好转组(19例)与未好转组(25例),随访时间3个月。4组间的比较采用Kruskal-Wallis H检验,组内比较采用Wilcoxon秩和检验,2组间的比较采用Mann-Whitney U检验;影响患者预后的独立危险因素用二元logistic回归分析,受试者工作特征曲线(ROC曲线)用于预测变量的准确性。结果肝硬化组、HBV-ACLF组、慢性肝炎组及健康组的MPV、血小板计数、PT、INR、Alb、BUN、TBil、MELD评分差异均有统计学意义(χ^2值分别为39.031、75.837、59.894、56.033、22.760、83.353、70.299,P值均<0.001)。各组间MPV进一步两两比较,HBV-ACLF组MPV明显高于健康组及慢性肝炎组,差异均有统计学意义(Z值分别为9.076、4.435,P校正值均<0.001);肝硬化组MPV明显高于健康组,差异有统计学意义(Z=2.646,P校正值=0.049)。HBV-ACLF患者中好转组与未好转组MPV、年龄、PT、INR、MELD评分差异均有统计学意义(Z值分别为-3.710、-2.726、-2.678、-2.322、-2.610,P值均<0.05);进一步二元logistic回归分析发现,MPV(OR=1.175,95%CI:1.067~2.756,P=0.026)和MELD评分(OR=1.643,95%CI:1.021~2.644,P=0.041)是影响HBV-ACLF预后的独立危险因素。MPV、MELD及二者联合对HBV-ACLF预后预测的ROC曲线下面积分别为0.742、0.731、0.791,MPV联合MELD的敏感度和特异度较高,分别为0.72、0.895。结论MPV是影响HBV-ACLF预后的独立危险因素,对预后具有良好的预测价值,MPV联合MELD评分预测HBV-ACLF预后比单独预测更有优势。Objective To investigate the association between mean platelet volume(MPV)and prognosis of hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF)and the value of MPV in prognostic evaluation.Methods A retrospective analysis was performed for the clinical data of 37 patients with hepatitis B cirrhosis,44 patients with HBV-ACLF,and 27 patients with chronic hepatitis B,who were admitted to Department of Infectious Diseases,The First Affiliated Hospital of Soochow University,from January 2015 to December 2019,as well as 24 individuals who underwent physical examination during the same period of time.Related clinical data included sex,age,total bilirubin(TBil),creatinine(Cr),blood urea nitrogen(BUN),albumin(Alb),blood ammonia(NH3),routine blood test results,Model for End-Stage Liver Disease(MELD)score,and blood coagulation parameters.According to prognosis,the patients with HBV-ACLF patients were divided into improvement group with 19 patients and non-improvement group with 25 patients,and the patients were followed up for 3 months.The Kruskal-Wallis H test was used for comparison between multiple groups,and the Wilcoxon rank sum test was used for comparison within each group,the Mann-Whitney U test was used for comparison between two groups;a binary logistic regression analysis was used to investigate the independent influencing factors for prognosis,and the receiver operating characteristic(ROC)curve was used to predict the accuracy of variables.Results There were significant differences in MPV,platelet count,prothrombin time(PT),international normalized ratio(INR),Alb,BUN,TBil,and MELD score between the liver cirrhosis group,the HBV-ACLF group,the chronic hepatitis group,and the healthy group(χ^2=39.031,75.837,59.894,56.033,22.760,83.353 and 70.299,all P<0.001).Further comparison of MPV between two groups showed that the HBV-ACLF group had a significantly higher MPV than the healthy group and the chronic hepatitis group(Z=9.076 and 4.435,both corrected P<0.001),and the liver cirrhosis group had a si

关 键 词：乙型肝炎病毒 慢加急性肝衰竭 平均血小板体积 预后 

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