乙型肝炎病毒相关肝衰竭患者人工肝治疗预后预测指标的研究  

Study on prognostic indicators for artificial liver therapy in patients with hepatitis B virus related liver failure

作　　者：罗嘉裕 胡江玲 许飞 姜曼蕾 郭丽丽 罗方云 曾宪强 LUO Jiayu;HU Jianging;XU Fei;JIANG Manei;GUO Lii;LUO Fangyun;ZENG Xianqiang(Department of Hepatology,the Fifth People's Hospital of Ganzhou City,Ganzhou Institute of Liver Disease,Ganzhou,Jiangxi,341000,China)

机构地区：[1]赣州市第五人民医院肝病科,赣州市肝病研究所,江西赣州341000

出　　处：《当代医学》2024年第3期86-92,共7页Contemporary Medicine

基　　金：江西省卫生健康委科技计划(202212317)。

摘　　要：目的探讨乙型肝炎病毒(HBV)相关肝衰竭患者人工肝治疗预后预测指标的应用意义。方法回顾性分析2019年1月至2021年12月于赣州市第五人民医院初次接受人工肝治疗的90例HBV相关肝衰竭患者的临床资料,按人工肝治疗方法分为血浆置换(PE)组和PE+血液滤过透析(CHDF)治疗(PE+CHDF)组,每组45例。收集患者临床资料,比较两组治疗前后肝功能及凝血功能变化,随访患者肝移植情况,单因素及多因素Logistic回归分析人工肝治疗后患者90d预后的影响因素。并按照患者90d预后结局分为存活组及死亡组,比较两组各项生化指标及终末期肝病模型(MELD)评分、MELD联合血清钠(Na)评分等指标对预后的预测价值。结果治疗4周,PE+CHDF组好转率为93.33%,高于PE组的71.11%,差异有统计学意义(P<0.05)。治疗后,两组丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBiL)水平均低于治疗前,凝血酶原时间(PT)短于治疗前,且PE+CHDF组ALT、AST、TBiL水平均低于PE组,PT短于PE组,差异有统计学意义(P<0.05);PE+CHDF组与PE组白蛋白(ALB)水平与治疗前及组间比较差异无统计学意义。存活组与死亡组性别、年龄、ALT水平、AST水平、ALB水平、HBV-DNA、肌酐(Cr)水平、肝性脑病、肝硬化占比、腹水、肝肾综合征占比比较差异无统计学意义;存活组TBiL水平、单核细胞-淋巴细胞比例(MLR)、中性粒细胞-淋巴细胞比例(NLR)、Cr水平、MELD评分、MELD-Na评分、NLR、国际标准化比值(INR)均低于死亡组,PT短于死亡组,甲胎蛋白高于死亡组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,NLR升高、MELD评分升高、MELD-Na升高、MLR升高是人工肝治疗后患者90d死亡的危险因素(P<0.05)。Spearson相关性分析结果显示,NLR、MLR、MELD评分、MELD-Na评分与90d预后呈正相关(r>0,P<0.05)。MELD预测短期预后的灵敏度为82.14%、特异度为80.65%,MELD-Na评分预Objective To explore the application significance of prognostic indicators for artificial liver therapy in patients with hepatitis B virus(HBV)related liver failure.Methods The clinical data of 90 patients with HBV related liver failure who received artificial liver treatment for the first time in the Fifth People's Hospital of Ganzhou City from January 2019 to December 2021 were retrospectively analyzed,they were divided into the plasma exchange(PE)group and PE+continuous hemodiafilitration(CHDF)treatment(PE+CHDF)group according to the artificial liver treat-ment method,with 45 cases in each group.The clinical data of the patients were collected,the changes of liver function and coagulation function be-fore and after treatment were compared between the two groups,and the liver transplantation of the patients was followed up,univariate and multivar-iate Logistic regression analysis was used to analyze the influencing factors of 90 d prognosis of patients after artificial liver treatment,the patients were divided into the survival group and the death group according to the 90 d prognosis,the predictive value of biochemical indicators,model for endstage liver disease(MELD)score,MELD combined with serum sodium(Na)score and other indicators for prognosis were compared between the two groups.Results After 4 weeks of treatment,the improvement rate of the PE+CHDF group was 93.33%,which was higher than 71.11%in the PE group,and the difference was statistically significant(P<0.05).After treatment,the levels of alanine aminotransferase(ALT),aspartate amino-transferase(AST)and total bilirubin(TBiL)of the two groups were lower than those before treatment,prothrombin time(PT)was shorter than that before treatment,and the levels of ALT,AST and TBiL in the PE+CHDF group were lower than those in the PE group,PT was shorter than that in the PE group,the differences were statistically significant(P<0.05);there was no significant difference in albumin(ALB)level between the PE+CHDF group and the PE group and compared with before tre

关 键 词：乙型肝炎病毒相关肝衰竭 人工肝 预后 终末期肝病模型评分 中性粒细胞-淋巴细胞比例 单核细胞-淋巴细胞比例 

分 类 号：R575.3[医药卫生—消化系统] R512.62[医药卫生—内科学]