血清游离三甲碘状腺原氨酸水平预测HBV相关慢加急性肝衰竭患者预后的价值分析  

Value of serum free triiodothyronine level in predicting the prognosis of patients with HBV-related acute-on-chronic liver failure

作　　者：张剑 陈煜 段钟平 ZHANG Jian;CHEN Yu;DUAN Zhongping(Difficult&Complicated Liver Diseases and Artificial Liver Center,Beijing YouAn Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院疑难肝病及人工肝中心,北京100069

出　　处：《临床肝胆病杂志》2022年第1期81-85,共5页Journal of Clinical Hepatology

基　　金：国家科技重大专项“艾滋病和病毒性肝炎等重大传染病防治”(2017ZX10302201-004-002)。

摘　　要：目的探讨血清游离三甲碘状腺原氨酸(FT3)水平对HBV相关慢加急性肝衰竭(HBV-ACLF)患者90 d预后的预测价值。方法收集2018年9月—2020年1月在首都医科大学附属北京佑安医院住院的122例HBV-ACLF患者的临床资料,根据确诊后90 d预后分为生存组(n=77)和死亡组(n=45)。采用ELISA法测定血清FT3水平,比较FT3水平在两组间差异,应用logistic回归分析探索影响预后的危险因素并建立FT3相关预测模型,采用预测概率值的ROC曲线下面积(AUC)评估预测模型的区分度,采用线性回归分析评估校准度。采用AUC比较模型与MELD评分预测预后价值的差异。符合正态分布的计量资料两组间比较采用t检验;非正态分布的计量资料两组间比较采用Mann-Whitney U检验;计数资料两组间比较采用χ2检验;采用logistic回归分析预后影响因素。结果死亡组FT3显著低于生存组[(2.27±0.38)pmol/L vs(2.69±0.55)pmol/L,t=4.526,P<0.001],FT3(OR=0.534,95%CI:0.300~0.950,P=0.013)是影响预后的独立保护因素;年龄(OR=1.047,95%CI:1.013~1.082,P=0.007)、TBil(OR=1.096,95%CI:1.059~1.134,P<0.001)、INR(OR=1.101,95%CI:1.029~1.178,P<0.005)、Cr(OR=4.583,95%CI:2.102~7.992,P<0.001)是独立危险因素。FT3相关预测模型区分度的AUC为0.869(95%CI:0.831~0.907),P<0.001;校准能力R^(2)=0.340,P=0.268。FT3相关公式预测预后的价值显著好于MELD评分(P<0.05)。结论FT3是HBV-ACLF患者90 d预后的独立影响因素,其与年龄、TBil、INR、Cr联合建立的FT3相关预测模型对患者90 d预后评估具有较好的预测价值。Objective To investigate the value of serum free triiodothyronine(FT3)level in predicting the 90-day prognosis of patients with hepatitis B virus(HBV)-related acute-on-chronic liver failure(ACLF).Methods Related clinical data were collected from 122 patients with HBV-ACLF who were hospitalized in Beijing YouAn Hospital,Capital Medical University,from September 2018 to January 2020,and according to their prognosis on day 90 after confirmed diagnosis,they were divided into survival group with 77 patients and death group with 45 patients.ELISA was used to measure the serum level of FT3,which was then compared between the two groups;a logistic regression analysis was used to investigate the risk factors for prognosis and establish an FT3-related predictive model;the area under the receiver operating characteristic(ROC)curve(AUC)of the predicted probability value was used to evaluate the discriminatory ability of the predictive model,and a linear regression analysis was used to evaluate calibration degree.AUC was used to compare the predictive value of this model and Model for End-Stage Liver Disease(MELD)score.The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups;univariate and multivariate logistic regression analyses were used to investigate the influencing factors for prognosis.Results The death group had a significantly lower serum level of FT3 than the survival group(2.27±0.38 pmol/L vs 2.69±0.55 pmol/L,t=4.526,P<0.001).FT3(odds ratio[OR]=0.534,95%confidence interval[CI]:0.300-0.950,P=0.013)was an independent protective factor against poor prognosis,while age(OR=1.047,95%CI:1.013-1.082,P=0.007),total bilirubin(TBil)(OR=1.096,95%CI:1.059-1.134,P<0.001),international normalized ratio(INR)(OR=1.101,95%CI:1.029-1.178,P<0.005),and creatinine(Cr)(OR=4.583,95%CI:2.102-7.992,P<0.001)w

关 键 词：慢加急性肝功能衰竭 三碘甲状腺原氨酸 预后 

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