乙型肝炎相关慢加急性肝衰竭合并原发性细菌性腹膜炎患者短期预后分析  

Short-term prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure combined with spontaneous bacterial peritonitis

作　　者：彭宇辉 刘诗洋 苏海滨 宁鹏 李会 严立龙 李晨 刘晓燕 陈婧 Peng Yuhui;Liu Shiyang;Su Haibin;Ning Peng;Li Hui;Yan Lilong;Li Chen;Liu Xiaoyan;Chen Jing(Senior Department of Hepatology,the Fifth Medical Center of PLA General Hospital,Beijing 100039,China;Senior Department of Infectious Diseases,the Fifth Medical Center of PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第五医学中心肝病医学部肝病科,北京100039 [2]解放军总医院第五医学中心感染病医学部,北京100039

出　　处：《国际流行病学传染病学杂志》2024年第2期99-103,共5页International Journal of Epidemiology and Infectious Disease

基　　金：国家重点研发计划(2021YFC2301801)。

摘　　要：目的探讨乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)合并原发性细菌性腹膜炎(SBP)患者短期预后及相应影响因素。方法回顾性分析2014年1月至2016年12月解放军总医院第五医学中心收治的171例HBV-ACLF合并SBP患者的临床资料。根据28 d生存情况分为生存组(n=114)和死亡组(n=57)。采用Logistic回归分析HBV-ACLF合并SBP患者28 d死亡的危险因素,并构建预测模型。绘制受试者工作特征曲线(ROC)分析预测模型对HBV-ACLF合并SBP患者28 d预后预测价值。结果死亡组患者肝性脑病(HE)发生率(68.42%,39/57)、急性肾损伤(AKI)发生率(73.68%,42/57)、WBC[10.23(6.88,14.82)×10^(9)/L]、ALT[137.00(51.00,370.00)U/L]、血糖(GLU)[5.70(4.10,7.60)mmol/L]、血肌酐(Cr)[112.00(89.00,147.00)μmol/L]、国际标准化比值(INR)[2.19(1.88,2.55)%]、终末期肝病模型(MELD)评分[28.29(24.95,33.10)]均高于生存组,差异有统计学意义(χ^(2)=18.900、18.714,Z=-3.757、-2.117、-2.085、-2.441、-2.423、-3.906,P<0.001、<0.001、<0.001、=0.034、0.037、0.016、0.013、<0.001)。多因素分析显示,血WBC(OR=1.120,95%CI:1.046~1.199)、GLU(OR=1.120,95%CI:1.018~1.232)、MELD评分(OR=1.089,95%CI:1.018~1.165)是HBV-ACLF合并SBP患者28 d死亡的独立危险因素,并构建预测模型Y=0.113GLU+0.113WBC+0.085MELD-4.967。该预测模型ROC曲线下面积为0.737,高于MELD评分的0.667(Z=-11.341,P<0.001)。结论HBV-ACLF合并SBP患者短期预后不佳,MELD评分、WBC和GLU是此类患者短期预后的影响因素,3者联合对短期预后的预测价值较高。Objective:To explore the short-term prognosis and related factors in patients with HBV-related acute-on-chronic liver failure(HBV-ACLF)complicated with spontaneous bacterial peritonitis(SBP).Methods:The clinical data of 171 patients with HBV-ACLF complicated with SBP admitted to the Fifth Medical Center of PLA General Hospital from January 2014 to December 2016 were retrospectively analyzed.Patients were divided into survival group(n=114)and death group(n=57)based on 28-day survival status.Logistic regression analysis was used to analyze the risk factors associated with 28-day mortality in patients with HBV-ACLF complicated with SBP,and to construct a prediction model.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the predictive value of the model for the short-term prognosis of patients with HBV-ACLF complicated with with SBP.Results:In the death group,the incidence rates of hepatic encephalopathy(HE)(68.42%,39/57),acute kidney injury(AKI)(73.68%,42/57),WBC[10.23(6.88,14.82)×10^(9)/L],ALT[137.00(51.00,370.00)U/L],blood glucose(GLU)[5.70(4.10,7.60)mmol/L],serum creatinine(Cr)[112.00(89.00,147.00)μmol/L],international normalized ratio(INR)[2.19(1.88,2.55)%],and model for end-stage liver disease(MELD)score[28.29(24.95,33.10)]were higher than those in the survival group,with statistically significant differences(χ^(2)=18.900,18.714,Z=-3.757,-2.117,-2.085,-2.441,-2.423,-3.906,P<0.001,<0.001,<0.001,=0.034,0.037,0.016,0.013,<0.001).Multivariate analysis showed that blood WBC(OR=1.120,95%CI:1.046-1.199),GLU(OR=1.120,95%CI:1.018-1.232),and MELD score(OR=1.089,95%CI:1.018-1.165)were independent risk factors for 28-day mortality in patients with HBV-ACLF complicated with SBP.A prediction model was constructed as Y=0.113GLU+0.113WBC+0.085MELD-4.967.The area under the ROC curve of the prediction model was 0.737,which was higher than that of the MELD score of 0.667(Z=-11.341,P<0.001).Conclusions:The short-term prognosis in patients with HBV-ACLF complicated with SBP is poor.MELD score,WBC,an

关 键 词：慢加急性肝衰竭 原发性细菌性腹膜炎 肝炎病毒 乙型 预后 

分 类 号：R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学] R572.2