年龄和D-二聚体联合终末期肝病模型对HBV相关慢加急性肝衰竭患者预后的预测价值  

Value of age and D-dimer combined with Model for End-Stage Liver Disease in predicting the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure

作　　者：董少雨 孙长宇[1] 乔芳芳 刘笑 张建营[2] DONG Shaoyu;SUN Changyu;QIAO Fangfang;LIU Xiao;ZHANG Jianying(Department of Infectious Diseases,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;School of Public Health,Zhengzhou University,Zhengzhou 450001,China)

机构地区：[1]郑州大学第一附属医院感染科,郑州450052 [2]郑州大学公共卫生学院,郑州450001

出　　处：《临床肝胆病杂志》2022年第11期2478-2482,共5页Journal of Clinical Hepatology

基　　金：国家科技重大专项子课题(2018ZX10302205-004)。

摘　　要：目的探讨年龄和D-二聚体(D-D)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2019年12月—2021年10月在郑州大学第一附属医院住院治疗的111例HBV-ACLF患者,根据确诊后90 d预后分为生存组(n=49)和死亡组(n=62)。收集患者的临床资料,包括年龄、性别、基础肝病、ALT、AST、TBil、Alb、D-D、PT、纤维蛋白原(FIB)、PTA、INR、SCr、血清钠(Na),并计算MELD评分。采用免疫比浊法测定血浆D-D水平。计量资料两组间比较采用t检验或Mann-Whitney U检验;计数资料两组间比较采用χ^(2)检验。采用二元Logistic回归分析影响患者预后的独立危险因素,受试者工作特征曲线(ROC曲线)用于评估预测变量的准确性。ROC曲线下面积(AUC)的比较采用Delong法。结果两组间年龄、TBil、D-D、PT、PTA、INR、SCr、Na、MELD评分比较差异均有统计学意义(P值均<0.05)。进一步二元Logistic回归分析发现,年龄(OR=1.088,95%CI:1.001~1.183,P=0.047)、D-D(OR=1.521,95%CI:1.078~2.145,P=0.017)和MELD评分(OR=1.892,95%CI:1.408~2.543,P<0.001)是影响HBV-ACLF患者预后的独立危险因素。年龄、MELD评分、D-D对HBV-ACLF预后预测的AUC分别为0.664、0.869、0.887,D-D联合年龄、年龄联合MELD评分、D-D联合MELD评分及三者联合的AUC分别为0.895、0.906、0.965、0.970,除D-D联合MELD评分外,三者联合的AUC较其他指标明显升高,差异均有统计学意义(P值均<0.05);三者联合的敏感度和特异度较高,分别是0.935、0.918。结论年龄、D-D、MELD评分是影响HBV-ACLF预后的独立危险因素,其中D-D和MELD评分对预后具有良好的预测价值,三者联合预测价值更高。Objective To investigate the value of age and D-dimer(D-D)combined with Model for End-Stage Liver Disease(MELD)score in predicting the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).Methods A total of 111 patients with HBV-ACLF who were hospitalized in The First Affiliated Hospital of Zhengzhou University from December 2019 to October 2021 were enrolled,and according to their prognosis on day 90 after confirmed diagnosis,they were divided into survival group with 49 patients and death group with 62 patients.Related clinical data were collected,including age,sex,underlying liver diseases,alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),Albumin(Alb),D-D,prothrombin time(PT),plasma fibrinogen(FIB),prothrombin activity(PTA),international normalized ratio(INR),serum creatinine(SCr),and serum sodium(Na),and MELD score was calculated.Immunoturbidimetric assay was used to measure the plasma level of D-D.The t-test or the Mann-Whitney U test was used for comparison of continuous data between the two groups,and the chi-square test was used for comparison of categorical data between the two groups;a binary Logistic regression analysis was used to investigate the independent risk factors for the prognosis of patients,and the receiver operating characteristic(ROC)curve was used to predict the accuracy of variables.Results There were significant differences between the two groups in age,TBil,D-D,PT,PTA,INR,SCr,Na,and MELD score(all P<0.05).The binary Logistic regression analysis showed that age(odds ratio[OR]=1.088,95%confidence interval[CI]:1.001-1.183,P=0.047),D-D(OR=1.521,95%CI:1.078-2.145,P=0.017),and MELD score(OR=1.892,95%CI:1.408-2.543,P<0.001)were independent risk factors for the prognosis of HBV-ACLF patients.Age,MELD score and D-D had an area under the ROC curve(AUC)of 0.664,0.869,and 0.887,respectively,in predicting the prognosis of HBV-ACLF,while D-D combined with age,age combined with MELD score,D-D combined with MELD score,and the c

关 键 词：乙型肝炎病毒 慢加急性肝功能衰竭 D-二聚体 预后 

分 类 号：R575.3[医药卫生—消化系统]