TBRR、TBCR对人工肝治疗HBV相关慢加急性肝衰竭患者预后的评估价值  

The prognostic value of TBRR and TBCR in patients with acute-on-chronic liver failure associated with hepatitis B treated with artificial liver

作　　者：周晓丽[1] 魏丽[1] 王兆勋[1] 杨学芳 施文娟[1] 万红[1] ZHOU Xiao-li;WEI Li;WANG Zhao-xun;YANG Xue-fang;SHI Wen-juan;WAN Hong(The Sencond People’s Hospital of Lanzhou,Gansu 730046,China)

机构地区：[1]兰州市第二人民医院感染科,甘肃730046

出　　处：《肝脏》2024年第5期542-544,556,共4页Chinese Hepatology

基　　金：兰州市科技发展指导性计划项目(2020-ZD-128);甘肃省卫生健康行业科研项目(GSWSQN2023-11)。

摘　　要：目的探讨血清总胆红素反弹率(TBRR)、总胆红素清除率(TBCR)对人工肝治疗HBV相关慢加急性肝衰竭(HBV-ACLF)预后的评估价值。方法收集2020年1月至2022年12月在兰州市第二人民医院行人工肝治疗的98例HBV-ACLF患者临床资料,根据临床结局分为好转组65例,死亡组33例。比较两组间血细胞、肝生化指标、凝血指标、MELD评分以及人工肝治疗后TBRR、TBCR差异;应用受试者工作特征曲线(ROC)计算人工肝治疗后有差异数值的曲线下面积(AUC)并得出最佳截断值。结果好转组PLT、INR、MELD评分和TBRR分别为(122.2±50.5)×10^(9)、1.7±0.5、18.8±5.2、(22.59±39.29)%;死亡组分别为(91.7±38.1)×10^(9)、2.0±0.5、21.9±4.8、(67.69±65.50)%,两组间差异有统计学意义(t=2.186,P=0.034;t=2.013,P=0.050;t=2.048,P=0.046;t=2.067,P=0.016);TBRR评估HBV-ACLF患者临床结局的曲线下面积(AUC)为0.709,95%CI(0.549~0.870),约登指数为0.408时,最佳截断值为71.13%,敏感度为50%,特异度为85.5%。结论HBV-ACLF患者人工肝治疗后死亡组TBRR值高于好转组,当TBRR>71.13%时,死亡风险极大。Objective To investigate the value of total bilirubin rebound rate(TBRR)and total bilirubin clearance rate(TBCR)in evaluating the prognosis of artificial liver therapy in patients with hepatitis B associated acute-on-chronic liver failure(HBV-ACLF).Methods An analysis was conducted on the clinical data of HBV-ACLF patients who had undergone artificial liver treatment at our hospital between January 2020 and December 2022.Patients were divided into an improvement group and a death group based on their clinical outcomes.Various parameters,including blood cells counts,liver biochemical indicators,coagulation indicators,MELD scores,as well as differences in TBRR and TBCR after artificial liver treatment,were compared between the two groups.Receiver operating characteristic curve(ROC)analysis was performed to determine the area under the curve(AUC)for these values and identify optimal cutoff points.Results A total of 98 HBV-ACLF patients with complete clinical data were included in the study.In the improvement group(65 cases),the levels of PLT、INR、MELD scores and TBRR were 122.2±50.5、1.7±0.5、18.8±5.2、22.59±39.29,respectively.In the death group(33 cases),the levels of PLT、INR、MELD scores and TBRR were 91.7±38.1、2.0±0.5、21.9±4.8、67.69±65.50,respectively.Statistically significant differences were observed between the two groups(t=2.186,P=0.03;t=0.013,P=0.050;t=2.048,P=0.046;t=2.067,P=0.016).The AUC for TBRR in predicting clinical outcomes in HBV-ACLF patients was 0.709,with a 95%CI of 0.549 to 0.870.The optimal cutoff value for TBRR was 71.13%,with a sensitivity of 50%and specificity of 85.5%at a Jordan index of 0.408.Conclusion Higher TBRR value after artificial liver treatment is associated with increased mortality in patients with HBV-ACLF.A TBRR value exceeding 71.13%may indicate a greater risk of death in this patient population.

关 键 词：TBRR TBCR 人工肝治疗 乙肝相关慢加急性肝衰竭 预后 评估价值 

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