基于炎症标志物的预测模型在肝衰竭患者短期预后评估中的应用价值研究  

Application value of prediction model based on inflammatory markers in short-term prognosis evaluation of patients with liver failure

作　　者：刘斐 杨倩倩 武瑞 刘春涛 傅晓晴[1] 刘寿荣 LIU Fei;YANG Qian-qian;WU Rui;LIU Chun-tao;FU Xiao-qing;LIU Shou-rong(Department of Severe Liver Disease,Hangzhou Xixi Hospital Affiliated to Zhejiang University School of Medicine,Hangzhou 310023,China)

机构地区：[1]浙江大学医学院附属杭州市西溪医院重症肝病科,浙江杭州310023

出　　处：《中国实用内科杂志》2023年第7期583-588,共6页Chinese Journal of Practical Internal Medicine

基　　金：浙江省医药卫生科技计划项目(2022KY276)。

摘　　要：目的探讨血白细胞计数、淋巴细胞计数、血尿素联合凝血酶原活动度在肝衰竭患者短期预后评估中的应用价值。方法回顾性收集2020年1月至2021年12月杭州市西溪医院收治的165例肝衰竭患者的临床资料,以入院治疗90天为观察时间节点,根据患者的转归分为研究组和对照组。logistic回归分析肝衰竭患者预后的影响因素,建立预测模型。预测模型与终末期肝病(MELD)评分、MELD-Na评分的相关性采用Spearman相关性分析。绘制受试者工作特征(ROC)曲线,判断各影响因素及预测模型的预测准确性。结果对照组的年龄、男性比例、白细胞计数(WBC)、中性粒细胞计数(NEU)、总胆红素(TBIL)、血尿素(BUN)、血肌酐(Cr)、MELD评分及MELD-Na评分和国际标准化比值(INR)均高于研究组(P<0.05),淋巴细胞计数(LYM)、前白蛋白(PA)、Na^(+)和凝血酶原活动度(PTA)低于研究组(P<0.05)。logistic回归分析显示WBC(OR 2.989,95%CI 1.268~7.046,P=0.012)、LYM(OR 0.386,95%CI 0.182~0.817,P=0.013)、BUN(OR 2.244,95%CI 1.051~4.794,P=0.037)和PTA(OR 0.180,95%CI 0.059~0.546,P=0.002)是肝衰竭患者预后的影响因素。WBC、LYM、BUN及PTA四者联合的logistic回归WLBP模型=2.3972+0.4107×WBC-1.6947×LYM-0.1147×PTA+0.1284×BUN。WLBP模型与MELD评分(r=0.715,P<0.001)、MELD-Na评分(r=0.729,P<0.001)呈正相关。WLBP模型的ROC曲线下面积(AUC)是0.836,优于单独使用WBC(AUC=0.634)、LYM(AUC=0.602)、BUN(AUC=0.648)或PTA(AUC=0.752)的预测价值(Z=-4.536,Z=-4.933,Z=-4.240,Z=-2.450;P<0.001,P<0.001,P=0.014,P=0.001)。结论WBC、LYM、BUN及PTA是肝衰竭患者短期预后的影响因素,四者联合的WLBP模型对肝衰竭患者短期预后的判断具有更高的临床价值。Objective To explore the application value of blood leukocyte count,lymphocyte count,and blood urea combined with prothrombin activity in the short-term prognosis evaluation in patients with liver failure.Methods The clinical data of 165 patients with liver failure admitted to Hangzhou Xixi hospital from January 2020 to December 2021 were collected retrospectively.Patients were divided into survival group and death group according to the disease outcome with 90 days of hospitalization as the observation time node.Logistic regression was used to analyze the risk factors affecting the prognosis of patients with liver failure,and established a predictive model.Spearman correlation analysis was used to analyze the correlation between the model and MELD score and MELD-Na score.The prediction performance was evaluated using a receiver operating characteristic(ROC)curve.Results The age,male ratio,WBC,NEU,TBIL,BUN,Cr,MELD score and MELD-Na score and INR were all higher in the death group than those in the survival group(P<0.05),while LYM,PA,Na^(+)and PTA were lower than those in the survival group(P<0.05).Logistic regression analysis showed that WBC(OR 2.989,95%CI 1.268-7.046,P=0.012),LYM(OR=0.386,95%CI 0.182-0.817,P=0.013),BUN(OR 2.244,95%CI 1.051-4.794,P=0.037)and PTA(OR 0.180,95%CI 0.059-0.546,P=0.002)were independent risk factors for the 90-day prognosis.The logistics regression model for the combination of WBC,LYM,BUN and PTA was 2.3972+0.4107×WBC-1.6947×LYM-0.1147×PTA+0.1284×BUN.Spearman correlation analysis suggested that the combined model was positively correlated with the MELD score(r=0.715,P<0.001)and MELD-Na score(r=0.729,P<0.001).The area under the ROC curve(AUC)of the combined model was 0.836,which outperformed the predictive value of WBC(AUC=0.634),LYM(AUC=0.602),BUN(AUC=0.648)orPTA(AUC=0.752)alone(Z=-4.536,Z=-4.933,Z=-4.240,Z=-2.450;P<0.001,P<0.001,P=0.014,P=0.001)。Conclusion WBC,LYM,BUN and PTA are independent predictive factors for short-term prognosis in patients with liver failure,and the four-c

关 键 词：肝功能衰竭 白细胞计数 淋巴细胞计数 尿素氮 凝血酶原活动度 预后 

分 类 号：R575.3[医药卫生—消化系统]