胱抑素C估算肾小球滤过率对人工肝治疗HBV相关性慢加急性肝衰竭短期预后的预测价值  

Clinical Value of Cystatin C-Based Estimated Glomerular Filtration Rate in Assessing Short-Term Mortality in Patients with Hepatitis B Virus-Related Acute-on-Chronic Liver Failure Treated with Artificial Liver Support System

作　　者：王鹭 吴晓娟[1] 蔡蓓[1] 胥劲[1] 魏彬[1] 袁宇珊 黄珣钡[1] 王婷婷[1] 王旻晋[1] 王兰兰[1] WANG Lu;WUXiao-juan;CAI Bei;XU Jin;WEI Bin;YUAN Yu-shan;HUANG Xun-bei;WANG Ting-ting;WANG Min-jin;WANG Lan-lan(Department of Laboratory Medicine/Research Centre of Clinical Laboratory Medicine,West China Hospital Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院实验医学科/临床检验医学研究中心,成都610041

出　　处：《四川大学学报（医学版）》2021年第5期862-867,共6页Journal of Sichuan University(Medical Sciences)

基　　金：国家自然科学基金青年基金(No.81702002);国家自然科学基金面上项目(No.81871713、No.81571561)资助。

摘　　要：目的探讨胱抑素C估算肾小球滤过率(cystatin C-based estimated glomerular filtration rate,eGFR-CysC)对人工肝治疗的乙型肝炎病毒相关性慢加急性肝功能衰竭(hepatitis B virus-related acute-on-chronic liver failure,HBVACLF)预后的预测价值。方法回顾性收集我院364例人工肝治疗的HBV-ACLF住院患者,根据28 d死亡率将患者分为存活组269例和死亡组95例,分析临床资料和实验室数据对患者短期预后的价值。结果多因素Cox回归分析显示,基线eGFR-CysC水平低是HBV-ACLF患者28 d死亡率的独立风险因素之一(风险比=0.987;95%置信区间:0.979~0.996,P=0.003)。基线eGFR-CysC水平与终末期肝病模型评分(the model for end-stage liver disease,MELD)(r=-0.439,P<0.001)、MELD联合血清钠评分(r=-0.481,P<0.001)和慢性肝衰竭联盟-慢加急性肝衰竭预后评分(Chronic Liver Failure Consortium ACLF,CLIF-C ACLF)(r=-0.340,P<0.001)呈负相关。受试者工作特性(receiver operating characteristic,ROC)曲线分析示基线值,第一次、第二次、第三次使用人工肝治疗后的eGFR-CysC值判断患者28 d死亡与否的曲线下面积分别为0.639、0.697、0.716、0.749(P<0.001),eGFR-CysC最佳临界值分别为70.620、67.525、61.725、64.685 mL/(min·1.73 m^(2))。结论eGFR-CysC水平能辅助评价人工肝治疗HBV-ACLF患者短期死亡率,动态监测的临床应用价值更高。Objective To evaluate the predictive value of using cystatin c-based estimated glomerular filtration rate(eGFR-CysC)in assessing the prognosis of hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF)patients treated with artificial liver support system(ALSS).Methods A total of 364 HBV-ACLF inpatients treated with ALSS at our hospital were enrolled retrospectively in the study.The patients were divided into the survival group(n=269)and non-survival group(n=95)according to mortality within 28 d,and their clinical information and laboratory data were analyzed for assessing short-term prognostic values.Results Multivariate Cox regression analysis identified eGFR-CysC as one of the independent risk factors associated with mortality within 28 days in HBV-ACLF patients(the hazard ratio=0.987;95%confidence interval,0.979-0.996,P=0.003).In addition,baseline eGFR-CysC was negatively correlated with the model for end-stage liver disease(MELD)score(r=-0.439,P<0.001),MELD plus sodium(MELD-Na)score(r=-0.481,P<0.001)and Chronic Liver Failure Consortium ACLF(CLIF-C ACLF)score(r=-0.340,P<0.001).Receiver operating characteristic(ROC)curve analysis showed area under the curve(AUC)of eGFR-CysC were 0.639,0.697,0.716,0.749 and the best cut-off value were 70.620,67.525,61.725,64.685 mL/(min·1.73 m^(2)),respectively,for baseline value and the first,second,and third treatment with ALSS.Conclusion eGFR-CysC could be used to assist clinical assessment of short-term mortality in HBV-ACLF patients treated with ALSS,and has better clinical application value for dynamic monitoring.

关 键 词：乙型肝炎相关性慢加急性肝衰竭 28 d死亡率 胱抑素C估算肾小球滤过率 人工肝治疗 

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