单核细胞与淋巴细胞比值动态变化对慢加急性乙型肝炎肝衰竭预后的诊断价值  

Diagnostic value of dynamic changes of monocyte-to-lymphocyte ratio in acute-on-chronic hepatitis B liver failure

作　　者：杨雪彦 吴寅平 吕丽[3] 赵泽华[1,2] 马行宇 李凤彩[1,2] 王凯[1,2] 范玉琛[1,2] YANG Xueyan;WU Yinping;LYU Li;ZHAO Zehua;MA Hangyu;LI Fengcai;WANG Kai;FAN Yuchen(Department of Hepatology,Qilu Hospital of Shandong University,Jinan 250012,Shandong,China;Institute of Hepatology,Shandong University,Jinan 250012,Shandong,China;Department of Outpatient and Follow Up Center,Qilu Hospital of Shandong University,Jinan 250012,Shandong,China)

机构地区：[1]山东大学齐鲁医院肝病科,山东济南250012 [2]山东大学肝病研究所,山东济南250012 [3]山东大学齐鲁医院预约随访科,山东济南250012

出　　处：《山东大学学报（医学版）》2024年第3期61-69,共9页Journal of Shandong University:Health Sciences

基　　金：国家自然科学基金(82270631);山东大学临床研究中心急危重症重点专项(2021SDUCRCB006)。

摘　　要：目的研究单核细胞与淋巴细胞比值(monocyte/lymphocyte ratio,MLR)动态变化对慢加急性乙型肝炎肝衰竭(acute-on-chronic hepatitis B liver failure,ACHBLF)患者临床预后的诊断价值。方法回顾性纳入2010年1月至2023年7月在山东大学齐鲁医院肝病科住院的ACHBLF患者,平滑曲线拟合与阈值效应分析MLR值与患者30 d死亡风险的非线性关系,Logistic回归分析和Boruta算法评估患者30 d预后的风险因素,受试者工作特征曲线(receiver operating characteristic curve,ROC)评估MLR的诊断价值,Bootstrap法验证MLR的诊断价值。结果共纳入ACHBLF患者243例,其中98例患者在30 d内死亡。入院第8天MLR值是患者30 d预后的独立风险因素(OR=1.33,95%CI:1.01~1.75,P=0.044),与30 d死亡风险呈非线性关系,入院第8天MLR值>1的患者死亡风险高于第8天MLR值≤1的患者(P<0.001)。入院第8天MLR值联合终末期肝病模型(model for end-stage liver disease,MELD)评分诊断30 d患者死亡的ROC曲线下面积为0.775(95%CI:0.69~0.86)。结论入院第8天MLR>1提示ACHBLF患者30 d的预后不良,动态监测MLR的变化有助于ACHBLF的临床诊疗。Objective To explore the diagnostic value of dynamic changes of monocyte/lymphocyte ratio(MLR)in the prognosis of acute-on-chronic hepatitis B liver failure(ACHBLF).Methods The study involved ACHBLF patients from January 2010 to July 2023 in the Department of Hepatology,Qilu Hospital of Shandong University.Smooth curve fitting and threshold effect analysis were used to evaluate the nonlinear relationship between MLR and 30-day mortality of ACHBLF patients.Logistic regression analysis and the Boruta algorithm were used to assess risk factors for 30-day mortality.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of MLR and the bootstrap method was used for internal validation.Results In this study,98 of the 243 individuals died within 30 days after hospitalization.MLR on the 8th day was identified as an independent risk factor for 30-day mortality of ACHBLF patients(OR=1.33,95%CI:1.01-1.75,P=0.044),which was reported to be nonlinearly associated with 30-day mortality.Patients with MLR>1 on the 8th day showed a higher risk of mortality than those with MLR≤1(P<0.001).ROC curve showed that combination of MLR on the 8th day and the model for end-stage liver disease(MELD)score presented the area under the ROC of 0.775(95%CI:0.69-0.86).Conclusion MLR>1 on the 8th day predicts poor 30-day prognosis in ACHBLF patients,and monitoring the dynamic changes of MLR is essential for the treatment of ACHBLF.

关 键 词：慢加急性乙型肝炎肝衰竭 单核细胞与淋巴细胞比值 预后 风险因素 

分 类 号：R575.3[医药卫生—消化系统]