IL-6联合终末期肝病模型评分对HBV相关慢加急性肝衰竭预后的预测价值  

Value of interleukin-6 combined with Model for End-Stage Liver Disease score in predicting the prognosis of hepatitis B virus-related acute-on-chronic liver failure

作　　者：王艳[1] 徐英[1] 孙蔚[1] 陈丽[1] 甘建和[1] 顾静[1] WANG Yan;XU Ying;SUN Wei;CHEN Li;GAN Jianhe;GU Jing(Department of Infectious Diseases,The First Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215006,China)

机构地区：[1]苏州大学附属第一医院感染科,江苏苏州215006

出　　处：《临床肝胆病杂志》2022年第8期1774-1779,共6页Journal of Clinical Hepatology

基　　金：国家科技部“十三五”重大专项(2017ZX10203201002-002);苏州市“科教兴卫”青年科技项目(KJXW2020003)。

摘　　要：目的探讨IL-6联合终末期肝病模型(MELD)评分对HBV相关慢加急性肝衰竭(HBV-ACLF)患者预后的预测价值。方法选取2015年1月—2018年12月于苏州大学附属第一医院住院的86例HBV-ACLF患者,根据随访90 d的生存情况分为死亡组(n=50)和存活组(n=36)。采用ELISA法测定血清IL-6水平,统计患者的一般资料。符合正态分布的计量资料两组间比较采用t检验,不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验;分类计数资料两组间比较采用χ^(2)检验。IL-6与其他变量行Pearson相关性分析,采用二元logistic回归分析影响HBV-ACLF患者预后的独立危险因素,利用ROC曲线评价IL-6联合MELD评分对HBV-ACLF预后的预测价值。结果死亡组与存活组红细胞比积(Hct)(t=2.413)、PLT(t=6.584)、TBil(t=-8.070)、PT(U=77.500)、国际标准化比值(INR)(U=102.000)、HBV DNA(t=-2.767)、IL-6(t=-16.543)、MELD评分(t=-8.192)组间差异有统计学意义(P值均<0.05);死亡组IL-6水平高于存活组[(27.13±12.18)pg/mL vs(9.72±5.56)pg/mL,P<0.001]。Pearson相关性分析结果显示,IL-6与TBil、PT呈显著正相关(r值分别为0.579、0.681,P值均<0.001)。运用二元logistic回归分析结果显示,IL-6(OR=1.480,95%CI:1.196~1.833,P=0.007)、MELD评分(OR=1.128,95%CI:1.033~1.231,P<0.001)是HBV-ACLF患者90 d死亡的独立预测因子。IL-6联合MELD评分模型的AUC(AUC=0.891,95%CI:0.778~0.999)高于IL-6(AUC=0.838,95%CI:0.687~0.989)、MELD评分(AUC=0.783,95%CI:0.634~0.933)。IL-6联合MELD评分模型对HBV-ACLF预后的预测价值高于IL-6(Z=-2.257,P=0.024)。结论IL-6联合MELD评分模型可作为评估HBV-ACLF患者短期预后较好的预测模型。Objective To investigate the value of interleukin-6(IL-6)combined with Model for End-stage Liver Disease(MELD)score in predicting the prognosis of patients with hepatitis B virus(HBV)-related acute-on-chronic liver failure(HBV-ACLF).Methods A total of 86 patients with HBV-ACLF who were hospitalized in The First Affiliated Hospital of Soochow University from January 2015 to December 2018 were enrolled,and according to their survival status after follow-up for 90 days,they were divided into death group with 50 patients and survival group with 36 patients.ELISA was used to measure the serum level of IL-6,and a statistical analysis was performed for general information.The t-test was used for comparison of normally distributed continuous data between 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.A Pearson correlation analysis was performed for IL-6 and other variables;a binary logistic regression analysis was used to investigate the independent risk factors for the prognosis of patients with HBV-ACLF;the receiver operating characteristic(ROC)curve was used to assess the value of IL-6 combined with MELD score in predicting the prognosis of HBV-ACLF.Results There were significant differences between the death group and the survival group in hematocrit(t=2.413),platelet count(t=6.584),total bilirubin(TBil)(t=-8.070),prothrombin time(PT)(U=77.500),international standardized ratio(U=102.000),HBV DNA(t=-2.767),IL-6(t=-16.543),and MELD score(t=-8.192),and the death group had a significantly higher level of IL-6 than the survival group(27.13±12.18 pg/mL vs 9.72±5.56 pg/mL,P<0.001).The Pearson correlation analysis showed that IL-6 was positively correlated with TBil and PT(r=0.579 and 0.681,both P<0.001).The binary logistic regression analysis showed that IL-6(odds ratio[OR]=1.480,95%confidence interval[CI]:1.196~1.833,P=0.007)and MELD score(OR=1.128,95%CI:1.033~1.231

关 键 词：乙型肝炎病毒 慢加急性肝功能衰竭 预后 

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