高密度脂蛋白胆固醇区分酒精性肝硬化Child-Turcotte-Pugh C级患者的临床价值  

The clinical value of HDL-C in differentiating patients with alcoholic liver cirrhosis of Child-Turcotte-Pugh grade C

作　　者：熊飞翔 董美乔 江宇泳[1] 杨玉英[1] 于浩[1] 姜婷婷[1] XIONG Feixiang;DONG Meiqiao;JIANG Yuyong;YANG Yuying;YU Hao;JIANG Tingting(Center of Integrative Medicine,Beijing Ditan Hospital,Capital Medical University,Beijing,100015,China;Graduate School of Dongzhimen Hospital,Affiliated to Beijing University of Chinese Medicine;Department of Infectious Diseases,the Third People's Hospital of Yingkou)

机构地区：[1]首都医科大学附属北京地坛医院中西医结合中心,北京100015 [2]北京中医药大学东直门医院研究生院 [3]营口市第三人民医院感染科

出　　处：《中国中西医结合消化杂志》2023年第9期706-711,共6页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

基　　金：首都卫生科研发展专项(No:首发2020-2-2172)。

摘　　要：目的:探究高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)区分酒精性肝硬化(alcoholic liver cirrhosis,ALC)患者Child-Turcotte-Pugh(CTP)分级C级的诊断价值。方法:选取2017年1月—2022年2月期间在首都医科大学附属北京地坛医院住院的488例ALC患者为研究对象,其中CTP A/B级患者347例,CTP C级患者141例,记录患者的性别、年龄、实验室指标;通过单因素和多因素二元logistic回归得出区分CTP C级的独立危险因素;绘制受试者工作特征曲线(receiver operating characteristic curve,ROC),得出曲线下面积(area under the curve,AUC),并根据约登指数计算cut-off值。结果:CTP C级患者HDL-C水平为0.5(0.3,0.7)mmol/L,低于CTP A/B级患者的HDL-C水平[0.8(0.6,1.1)mmol/L]。通过单因素和多因素logistic回归显示,WBC(OR=1.184,95%CI:1.086~1.291,P<0.001),RBC(OR=0.658,95%CI:0.480~0.901,P<0.001),AST(OR=1.008,95%CI:1.000~1.016,P=0.044),HDL-C(OR=0.604,95%CI:0.434~0.841,P<0.001)是诊断ALC患者肝功能进展到CTP C级的独立危险因素。绘制HDL-C的ROC曲线,得出AUC为0.760,显著高于TC、TG、LDL-C的AUC,分别为0.629、0.589、0.535;根据约登指数得出HDL-C的cut-off值是0.655 mmol/L,以HDL-C 0.655 mmol/L为界值将患者分为低风险组和高风险组,发现低风险组HDL-C患者的肝功能更差。结论:CTP C级ALC患者的HDL-C水平显著低于CTP A/B级患者,HDL-C对CTP分级有一定的参考价值,可以作为ALC患者CTP分级的辅助指标。Objective To investigate the clinical value of high-density lipoprotein cholesterol(HDL-C)to identify alcoholic liver cirrhosis(ALC)patients in Child-Turcotte-Pugh(CTP)class C.Methods This retrospective study enrolled 488 patients with ALC who were hospitalized in Beijing Ditan Hospital of Capital Medical University between January 2017 and February 2022,including 347 patients with CTP grade A/B,and 141 patients with CTP grade C.Gender,age,and laboratory indexes of the patients were recorded;univariate and multifactorial binary logistic regression was employed to identify independent risk factors for determining CTP classification.The efficacy of these factors was evaluated through the receiver operating characteristic curve(ROC).The area under the curve(AUC)was derived to assess the diagnostic value,and the best cut-off value was calculated based on the Youden index.Results HDL-C levels in CTP class C patients were 0.5(0.3,0.7)mmol/L,which were lower than CTP class A/B patients(0.8[0.6,1.1]mmol/L).Through univariate and multivariate logistic regression,WBC(OR=1.184,95%CI:1.086-1.291,P<0.001),RBC(OR=0.658,95%CI:0.480-0.901,P<0.001),AST(OR=1.008,95%CI:1.000-1.016,P=0.044)and HDL-C(OR=0.604,95%CI:0.434-0.841,P<0.001)were independent risk factors for the diagnosis of liver function in patients with ALC CTP class C.The AUC of HDL-C was 0.760,which was significantly higher than the AUC of TC(0.629),TG(0.589),and LDL-C(0.535).The cut-off value of HDL-C was 0.655 mmol/L based on the Youden index;with HDL-C≤0.655 mmol/L as the boundary value patients were divided into low-risk groups and high-risk groups and it was found that patients with low levels of HDL-C had worse liver function.Conclusion HDL-C levels in ALC patients have some reference value for CTP grading,and can be used as an auxiliary index for CTP grading.

关 键 词：酒精性肝硬化 血脂 Child-Turcotte-Pugh分级 高密度脂蛋白胆固醇 

分 类 号：R473.5[医药卫生—护理学]