高密度脂蛋白胆固醇对HBV相关慢加急性肝衰竭严重程度及预后的预测价值  

Value of high-density lipoprotein cholesterol in evaluating the severity and prognosis of hepatitis B virus-associated acute-on-chronic liver failure

作　　者：徐英[1] 黄小平[1] 陈丽[1] 孙蔚[1] 李文婷 王艳[1] 甘建和[1] XU Ying;HUANG Xiaoping;CHEN Li;SUN Wei;LI Wenting;WANG Yan;GAN Jianhe(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,江苏苏州215000

出　　处：《临床肝胆病杂志》2021年第7期1632-1635,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：目的探讨高密度脂蛋白胆固醇(HDL-C)与HBV相关慢加急性肝衰竭(HBV-ACLF)预后的关系及其预测价值。方法选取苏州大学附属第一医院感染科2015年1月—2019年1月收治的肝病患者,根据病情发展的不同阶段,分为HBV-ACLF组(n=42),肝硬化组(n=30)和慢性肝炎组(n=25),同时选取同期健康者(n=24)作为对照。收集患者一般临床资料,包括性别、年龄、PT、Alb、TBil、SCr、尿素氮(BUN)、TC、TG、HDL-C、LDL-C、MELD评分。其中HBV-ACLF组进一步分为好转组(n=17)与未好转组(n=25),随访时间3个月。不符合正态分布的连续性变量两组间比较采用Mann-Whitney U检验,多组间比较采用Kruskal-Wallis H检验,进一步组内比较采用Wilcoxon秩和检验;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)用于分析预测变量的准确性。结果肝硬化组、HBV-ACLF组、慢性肝炎组、健康组在PT、Alb、BUN、TBil、TC、TG、HDL-C、LDL-C、MELD评分上差异均有统计学意义(χ^(2)值分别为75.134、44.638、10.253、80.357、55.067、19.858、68.174、52.492、64.359,P值均<0.05)。各组间进一步两两比较发现,HDL-C水平在HBV-ACLF组[0.12(0.08-0.30)mmol/L]明显低于肝硬化组[0.79(0.60-1.01)mmol/L]、慢性肝炎组[1.06(0.88-1.44)mmol/L]、健康组[2.03(1.36-2.98)mmol/L](Z值分别为3.821、5.921、7.228,P值均<0.001)。HBV-ACLF好转组HDL-C水平明显高于未好转组[0.20(0.11-0.49)mmol/L vs 0.10(0.07-0.15)mmol/L,Z=-1.628,P=0.014]。进一步二元logistic回归,发现HDL-C(OR=0.003,95%CI:0-0.548,P=0.029)与MELD评分(OR=1.588,95%CI:1.032-2.443,P=0.035)是影响HBV-ACLF预后的独立危险因素。HDL-C对HBV-ACLF预后预测的ROC曲线下面积(AUC)为0.807,截断值为0.175 mmol/L,敏感度0.706,特异度0.800,95%CI:0.677-0.937,P=0.001;MELD对HBV-ACLF预后预测的AUC为0.822,截断值为26.500,敏感度0.760,特异度0.765,95%CI:0.696-0.928,P<0.001。结论HDL-C是HBV-ACLF患者预后的独立危险Objective To investigate the association of high-density lipoprotein cholesterol( HDL-C) with the prognosis of hepatitis B virus-associated acute-on-chronic liver failure( HBV-ACLF) and its predictive value. Methods The patients with liver disease who were admitted to Department of Infectious Diseases,The First Affiliated Hospital of Soochow University,from January 2015 to January 2019 were enrolled,and according to the stage of disease progression,they were divided into HBV-ACLF group with 42 patients,liver cirrhosis group with 30 patients,and chronic hepatitis group with 25 patients. A total of 24 healthy individuals were enrolled as healthy control group.General clinical data were collected,including sex,age,prothrombin time( PT),albumin( Alb),total bilirubin( TBil),serum creatinine,blood urea nitrogen( BUN),total cholesterol( TC),triglyceride( TG),HDL-C,low-density lipoprotein cholesterol( LDL-C),and Model for End-Stage Liver Disease( MELD) score. The HBV-ACLF group was further divided into improvement group with 17 patients and non-improvement group with 25 patients,and the patients were followed up for 3 months. The Mann-Whitney U test was used for comparison of non-normally distributed continuous variables between two groups;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. A binary logistic regression analysis was used to investigate independent risk factors for prognosis,and the receiver operating characteristic( ROC) curve was used to evaluate the accuracy of the variables in prediction. Results There were significant differences in PT,Alb,BUN,TBil,TC,TG,HDL-C,LDL-C,and MELD scores between the liver cirrhosis group,the HBV-ACLF group,the chronic hepatitis group,and the healthy control group ( χ2= 75. 134,44. 638,10. 253,80. 357,55. 067,19. 858,68. 174,52. 492,and 64. 359,all P < 0. 05). Further comparison between two groups showed that the HBV-ACLF group had a significantly lower level of HDL-C than the li

关 键 词：乙型肝炎病毒 慢加急性肝衰竭 胆固醇 HDL 预后 

分 类 号：R575.3[医药卫生—消化系统] R512.62[医药卫生—内科学]