乙型肝炎病毒相关慢加急性肝衰竭危险因素及其新型生存预测模型研究  

Study on HBV-related acute-on-chronic liver failure risk factors and novel predictive survival model

作　　者：汤玉会 张潇潇 张思雨[1] 崔璐瑶 王一奇 薛宁宁 李路 赵丹丹[1] 南月敏[1] Tang Yuhui;Zhang Xiaoxiao;Zhang Siyu;Cui Luyao;Wang Yiqi;Xue Ningning;Li Lu;Zhao Dandan;Nan Yuemin(Department of Traditional and Western Medical Hepatology,Third Hospital of Hebei Medical University,Hebei Key Laboratory of Mechanism of Liver Fibrosis in Chronic Liver Disease,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院中西医结合肝病科、河北省慢性肝病肝纤维化机制研究重点实验室,石家庄050051

出　　处：《中华肝脏病杂志》2023年第1期84-89,共6页Chinese Journal of Hepatology

基　　金：2019年河北省重点研发计划项目(19277779D);河北省引进国外智力项目。

摘　　要：目的明确乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)诱因、临床特征、疾病进展危险因素,并建立新型生存预测模型,评估其应用价值。方法依据中华医学会肝病学分会《肝衰竭诊疗指南(2018年版)》,选择HBV-ACLF 153例,分析其诱发因素、基础肝病阶段及其治疗药物、临床特征及生存状况的影响因素。Cox比例风险回归分析筛选预后影响因素,构建新型预测模型,应用受试者操作特征曲线(ROC)评估其与终末期肝病模型(MELD)、慢性肝衰竭联合慢加急性肝衰竭(CLIF-C ACLF)评分预测价值。结果80.39%(123/153)为乙型肝炎肝硬化基础上发生ACLF。HBV-ACLF诱发因素以停用核苷(酸)类似物(NAs)和应用肝毒性药物为主,肝毒性药物包括中成药/中草药、非甾体类抗炎药、抗结核药物、中枢神经系统药物、抗肿瘤药物等。34.64%患者诱因不明。临床多以进展性黄疸、纳差、乏力起病,合并肝性脑病、上消化道出血、肝肾综合征及感染等并发症患者短期病死率显著增高(P<0.05)。乳酸脱氢酶、白蛋白、国际标准化比值、中性粒细胞与淋巴细胞比值、肝性脑病及上消化道出血是影响患者生存状况的独立预测因子,依此构建LAINeu模型,评估HBV-ACLF生存情况的ROC曲线下面积为0.886,显著高于MELD、CLIF-C ACLF评分(P<0.05),当LAINeu评分≥-3.75时,预后较差。结论停用NAs和使用肝毒性药物为HBV-ACLF常见诱发因素,肝功能失代偿相关并发症及感染加速疾病进展。LAINeu模型可较准确预测患者生存情况。Objective To identify the predisposing factors,clinical characteristics,and risk factors of disease progression to establish a novel predictive survival model and evaluate its application value for hepatitis B virus-related acute-on-chronic liver failure.Methods 153 cases of HBV-ACLF were selected according to the guidelines for the diagnosis and treatment of liver failure(2018 edition)of the Chinese Medical Association Hepatology Branch.Predisposing factors,the basic liver disease stage,therapeutic drugs,clinical characteristics,and factors affecting survival status were analyzed.Cox proportional hazards regression analysis was used to screen prognostic factors and establish a novel predictive survival model.The receiver operating characteristic curve(ROC)was used to evaluate predictive value with the Model for End-Stage Liver Disease(MELD)and the Chronic Liver Failure Consortium Acute-on-Chronic Liver Failure score(CLIF-C ACLF).Results 80.39%(123/153)based on hepatitis B cirrhosis had developed ACLF.HBV-ACLF’s main inducing factors were the discontinuation of nucleos(t)ide analogues(NAs)and the application of hepatotoxic drugs,including Chinese patent medicine/Chinese herbal medicine,non-steroidal anti-inflammatory drugs,anti-tuberculosis drugs,central nervous system drugs,anti-tumor drugs,etc.34.64%of cases had an unknown inducement.The most common clinical symptoms at onset were progressive jaundice,poor appetite,and fatigue.The short-term mortality rate was significantly higher in patients complicated with hepatic encephalopathy,upper gastrointestinal hemorrhage,hepatorenal syndrome,and infection(P<0.05).Lactate dehydrogenase,albumin,the international normalized ratio,the neutrophil-to-lymphocyte ratio,hepatic encephalopathy,and upper gastrointestinal bleeding were the independent predictors for the survival status of patients.The LAINeu model was established.The area under the curve for evaluating the survival of HBV-ACLF was 0.886,which was significantly higher than the MELD and CLIF-C ACLF scores(P<0.05

关 键 词：乙型肝炎病毒 慢加急性肝衰竭 危险因素 预后 

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