终末期肝病模型评分联合降钙素原在乙型肝炎病毒相关慢加急性肝衰竭发生急性肾损伤的预测作用  

Predictive Effect of Model for End-stage Liver Disease Score Combined with Procalcitonin on Acute Kidney Injury in Hepatitis B Virus-related Acute-on-chronic Liver Failure

作　　者：王春旭 王林[1] 王洪岩 Wang Chunxu;Wang Lin;Wang Hongyan(Department of Intensive Care Medicine,the First Affiliated Hospital of Harbin Medical University,Harbin 150001)

机构地区：[1]哈尔滨医科大学附属第一医院重症医学科,哈尔滨150001

出　　处：《国际老年医学杂志》2024年第1期76-81,共6页International Journal of Geriatrics

基　　金：黑龙江省自然科学基金(Y2019Q06)。

摘　　要：目的探究终末期肝病模型(MELD)评分联合降钙素原(PCT)对乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者发生急性肾损伤的预测价值。方法对2019年1月—2022年12月哈尔滨医科大学附属第一医院住院治疗的216例HBV-ACLF患者进行回顾性分析。根据住院期间是否发生急性肾损伤,分为急性肾损伤组(51例)和非急性肾损伤组(165例)。收集患者的临床资料,采用多因素logistic回归模型分析筛选HBV-ACLF患者并发急性肾损伤的影响因素,并采用ROC曲线评价MELD评分联合PCT对HBV-ACLF患者急性肾损伤发生的预测价值。结果单因素分析显示,两组的年龄、白蛋白、凝血酶原时间、PCT、急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)、MELD评分比较,差异均有统计学意义(P<0.05)。多因素logistic回归模型分析结果显示,PCT、APACHEⅡ评分、MELD评分是HBV-ACLF患者住院期间发生急性肾损伤的独立危险因素(P<0.05)。ROC曲线显示,MELD评分联合PCT预测HBV-ACLF患者住院期间发生急性肾损伤的曲线下面积高于MELD评分、PCT单一指标。结论MELD评分、PCT升高是HBV-ACLF并发急性肾损伤的独立危险因素,两者联合应用可预测住院期间急性肾损伤发生的风险,以辅助临床对患者进行管理。Objective To investigate the predictive value of the model for end-stage liver disease(MELD)score combined with procalcitonin(PCT)for acute kidney injury in patients with hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF).Methods A retrospective analysis of 216 HBV-ACLF patients hospitalized in the First Affiliated Hospital of Harbin Medical University from January 2019 to December 2022 was performed.According to whether acute kidney injury occurred during hospitalization,they were divided into an acute kidney injury group(51 cases)and a non acute kidney injury group(165 cases).The clinical data of the patients was collected,A multivariate logistic regression model was used to screen the influencing factors of acute kidney injury in HBV-ACLF patients,and the ROC curve was used to evaluate the predictive value of MELD score combined with PCT for the occurrence of acute kidney injury in HBV-ACLF patients.Results Univariate analysis showed that there were significant differences in age,albumin,prothrombin time,PCT,acute physiology and chronic health evaluationⅡ(APACHEⅡ),and MELD scores between the two groups(P<0.05).The results of multivariate logistic regression analysis showed that PCT,APACHEⅡscore,and MELD score were independent risk factors for acute kidney injury during hospitalization in HBV-ACLF patients(P<0.05).ROC curve showed that MELD score combined with PCT predicted the area under the curve of acute kidney injury during hospitalization in HBV-ACLF patients higher than MELD score and PCT single index.Conclusion Elevated MELD score and PCT are independent risk factors for AKI complicating HBV-ACLF,and the combined use can predict the risk of acute kidney injury during hospitalization to assist clinical management of patients.

关 键 词：慢加急性肝衰竭 急性肾损伤 终末期肝病模型 炎症 

分 类 号：R512.62[医药卫生—内科学] R692[医药卫生—临床医学] R575.3