外周血淋巴细胞计数在慢加急性肝衰竭短期预后评估中的价值  

Value of peripheral blood lymphocyte count in evaluating the short-term prognosis of patients with acute-on-chronic liver failure

作　　者：刘小花 杨淑娟 刘瑜珊 李娟[1,2,3,4] 张巧[1,2,3,4] 王亚敏 闫涛涛 杨瑗 赵英仁[1,2,3,4] 何英利 LIU Xiaohua;YANG Shujuan;LIU Yushan;LI Juan;ZHANG Qiao;WANG Yamin;YAN Taotao;YANG Yuan;ZHAO Yingren;HE Yingli(Department of Infectious Diseases,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Clinical Research Center for Infectious Diseases,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Regional Medical Center for Infectious Diseases,Xi’an 710061,China;Shaanxi Provincial Clinical Medical Research Center of Infectious Diseases,Xi’an 710061,China;Department of Hepatology,Xi’an Eighth Hospital Affiliated to Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院感染科,西安710061 [2]西安交通大学第一附属医院感染病临床研究中心,西安710061 [3]国家传染病区域医疗中心,西安710061 [4]陕西省感染性疾病临床医学研究中心,西安710061 [5]西安交通大学附属西安市第八医院肝病科,西安710061

出　　处：《临床肝胆病杂志》2023年第10期2383-2389,共7页Journal of Clinical Hepatology

基　　金：国家自然科学基金(81971310);陕西省感染性疾病临床医学研究中心项目(2020LCZX-01);西安交通大学第一附属医院感染病临床研究中心项目(XJTU1AF2021CRF-006,2022-XKCRC-04);陕西省重点研发项目(2018ZDXM-SF-037)。

摘　　要：目的 探讨慢加急性肝衰竭(ACLF)患者预后影响因素,建立短期预后模型。方法 回顾2011年1月—2016年12月在西安交通大学第一附属医院感染科住院的247例ACLF患者的基线临床资料。将患者分为生存组及死亡组,比较组间差异,分析预后影响因素,同时建立预后模型,应用受试者工作特征曲线(ROC曲线)评估预测效能并确定最佳截断值。正态分布的计量资料两组间比较采用成组t检验;不服从正态分布的资料两组间比较采用Mann-Whitney U秩和检验;计数资料两组间比较采用Fisher精确检验或Pearson卡方检验。Logistic单因素及多因素分析28天、90天预后相关的独立危险因素。使用Kaplan-Meier方法绘制28天生存曲线。结果 经纳入及排除标准筛选后共纳入ACLF患者220例,28天生存组148例、死亡组72例,28天无移植生存率67.27%;90天生存组115例、死亡组105例,90天无移植生存率52.27%。Logistic回归分析结果显示女性(OR=2.149,P=0.030)、高MELD评分(OR=1.120,P<0.001)、外周血低淋巴细胞计数(OR=0.411,P=0.002)是影响28天预后的独立危险因素;据此建立影响28天预后的LS-MELD模型:-3.432+0.765×性别-0.890×淋巴细胞计数×10-9+0.113×MELD(性别赋值:男性为1,女性为2)。经ROC曲线确定模型的最佳截断值为0.35,据此将患者分为低LS-MELD组(≤0.35)及高LS-MELD组(>0.35),低LS-MELD组的28天生存率显著高于高LS-MELD组(P<0.001)。结论 外周血淋巴细胞计数及性别联合MELD评分对ALCF患者的短期预后具有预测价值。Objective To investigate the influencing factors for the prognosis of patients with acute-on-chronic liver failure(ACLF),and to establish a short-term prognostic model.Methods A retrospective analysis was performed for the baseline clinical data of 247 patients with ACLF who were hospitalized in Department of Infectious Diseases,The First Affiliated Hospital of Xi’an Jiaotong University,from January 2011 to December 2016,and the patients were divided into survival group and death group.The two groups were compared to identify the influencing factors for prognosis;a prognostic model was established,and the receiver operating characteristic(ROC)curve was used to assess its predictive efficacy and determine the optimal cut-off value.The independent-samples t test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data between groups;the Fisher’s exact test or the Pearson’s chi-square test was used for comparison of categorical data between groups.The univariate and multivariate logistic regression analyses were used to investigate the independent risk factors for 28-and 90-day prognosis,and the Kaplan-Meier method was used to plot the 28-day survival curves.Results A total of 220 patients with ACLF were included based on the inclusion and exclusion criteria;there were 148 patients in the 28-day survival group and 72 patients in the 28-day death group,with a 28-day transplantation-free survival rate of 67.27%;there were 115 patients in the 90-day survival group and 105 patients in the 90-day death group,with a 90-day transplantation-free survival rate of 52.27%.The logistic regression analysis showed that female sex(odds ratio[OR]=2.149,P=0.030),high Model for End-Stage Liver Disease(MELD)score(OR=1.120,P<0.001),and low lymphocyte count(OR=0.411,P=0.002)were independent risk factors for 28-day prognosis,and an LS-MELD model for 28-day prognosis was established as Logit(28-day prognosis

关 键 词：慢加急性肝功能衰竭 危险因素 淋巴细胞计数 预后 

分 类 号：R575.3[医药卫生—消化系统]