总胆红素反弹率与总胆红素清除率在人工肝治疗重症药物性肝损伤预后评估中的作用  

Value of total bilirubin rebound rate and total bilirubin clearance rate in evaluating the prognosis of severe drug-induced liver injury after artificial liver support therapy

作　　者：刘莹[1] 朱萍[1] 梁静[1] 向慧玲[1] LIU Ying;ZHU Ping;LIANG Jing;XIANG Huiling(Department of Gastroenterology and Hepatology,Tianjin Third Central Hospital,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases,Artificial Cell Engineering Technology Research Center,Tianjin Institute of Hepatobiliary Disease,Tianjin 300170,China)

机构地区：[1]天津市第三中心医院消化肝病科,天津市重症疾病体外生命支持重点实验室,天津市人工细胞工程技术研究中心,天津市肝胆疾病研究所,天津300170

出　　处：《临床肝胆病杂志》2023年第3期606-612,共7页Journal of Clinical Hepatology

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-034A);天津市卫生健康科技项目重点学科专项资助(TJWJ2022XK029);北京肝胆相照公益基金(RGGJJ-2021-014)。

摘　　要：目的评估总胆红素反弹率(TBRR)、总胆红素清除率(TBCR)及治疗1周后总胆红素清除率(ΔTBCR)在人工肝治疗重症药物性肝损伤短期预后评估中的作用。方法回顾性分析2013年9月—2021年12月在天津市第三中心医院住院并行人工肝治疗的重症药物性肝损伤患者203例,收集患者的一般资料、生化指标及临床分型,根据患者出院时病情转归分为好转组和未愈组,并计算MELD评分、TBRR、TBCR及ΔTBCR。正态分布的计量资料,两组间比较采用独立样本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χ^(2)检验。绘制受试者工作特征曲线(ROC曲线)用来评估各个评价指标对患者预后的预测价值。Kaplan-Meier法用来描述不同评价指标下患者住院时间的差异。结果好转组患者的年龄(t=-2.762)、WBC(Z=-3.184)、TBil(t=-2.809)、CBil(t=-2.739)、INR(Z=-2.357)、MELD评分(t=-3.090)、TBRR(t=-4.749)低于未愈组,而Alb(t=2.198)、PTA(t=2.018)、TBCR(t=2.166)、ΔTBCR(t=9.549)则高于未愈组(P值均<0.05)。MELD评分、TBRR、TBCR及ΔTBCR的ROC曲线下面积分别为0.656、0.727、0.611和0.879,ΔTBCR在预测价值上优于TBRR(Z=3.169,P=0.0015)。TBRR、ΔTBCR最佳临界值为22.5%(敏感度94.6%,特异度45.2%)、27.4%(敏感度77.7%,特异度86.5%)。而对于不同的临床病理分型,ΔTBCR均显示出良好的预测价值,特别是对混合型DILI患者进行人工肝治疗的疗效评价具有极高的敏感度(91.4%)和特异度(100.0%)。结论TBRR、ΔTBCR对人工肝治疗重症药物性肝损伤患者短期预后评估中作用优于MELD评分,其中ΔTBCR评分的预测价值更高。Objective To investigate the value of total bilirubin rebound rate(TBRR),total bilirubin clearance rate(TBCR),and TBCR after 1 week of treatment(ΔTBCR)in evaluating the short-term prognosis of patients with severe drug-induced liver injury(DILI)after artificial liver support therapy.Methods A retrospective analysis was performed for 203 patients with severe DILI who received artificial liver support therapy in Tianjin Third Central Hospital from September 2013 to December 2021,and general information,biochemical parameters,and clinical classification were collected.The patients were divided into improved group and unhealed group according to the prognosis at discharge,and Model for End-Stage Liver Disease(MELD)score,TBRR,TBCR,andΔTBCR were calculated.The independent samples 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 groups;the chi-square test was used for comparison of categorical data between groups.The receiver operating characteristic(ROC)curve was plotted to investigate the value of assessment indices in predicting the prognosis of patients,and the Kaplan-Meier method was used to investigate the difference in the length of hospital stay in the context of different assessment indices.Results Compared with the unhealed group,the improved group had significantly lower age(t=-2.762,P<0.05),white blood cell count(Z=-3.184,P<0.05),total bilirubin(t=-2.809,P<0.05),conjugated bilirubin(t=-2.739,P<0.05),international normalized ratio(Z=-2.357,P<0.05),MELD score(t=-3.090,P<0.05),and TBRR(t=-4.749,P<0.05),as well as significantly higher albumin(t=2.198,P<0.05),prothrombin time activity(t=2.018,P<0.05),TBCR(t=2.166,P<0.05),andΔTBCR(t=9.549,P<0.05).MELD score,TBRR,TBCR,andΔTBCR had an area under the ROC curve(AUC)of 0.656,0.727,0.611,and 0.879,respectively,andΔTBCR had a better predictive value than TBRR(Z=3.169,P=0.0015).The optimal cut-off value was 22.5%for TBRR(with a

关 键 词：化学性与药物性肝损伤 肝 人工 胆红素 

分 类 号：R575[医药卫生—消化系统]