乙肝肝硬化腹水患者发生急性肾损伤的影响因素及预测模型  

Influencing factors and prediction models for AKI in ascites patients with hepatitis B cirrhosis

作　　者：褚雪倩 周炜 黄萱[1] 帕提古丽·买买提 李素华[1] Chu Xue-qian;Zhou Wei;Huang Xuan;Pa Tiguli·Maimaiti;Li Su-hua(Nephrology Center,First Affiliated Hospital,Xinjiang Medical University,Urumqi 830054,China;Department of Nephrology,People's Hospital,Zhongshan Torch Development Zone,Zhongshan 528400,China)

机构地区：[1]新疆医科大学第一附属医院肾脏疾病中心,乌鲁木齐830054 [2]中山火炬开发区人民医院肾病科,中山528400

出　　处：《临床肾脏病杂志》2024年第8期623-628,共6页Journal Of Clinical Nephrology

基　　金：省部共建中亚高发病成因与防治国家重点实验室,新疆医科大学第一附属医院肾脏疾病中心(SKL-HIDCA-2021-8);国家自然科学基金地区基金项目(82360139);新疆维吾尔自治区自然科学基金青年科学基金项目(2022D01C761)。

摘　　要：目的探讨乙肝肝硬化合并腹水患者发生急性肾损伤(acute kidney injury,AKI)的预测因素,建立新型预测模型。方法收集2018年1月1日至2022年12月31日在新疆医科大学第一附属医院感染科住院并确诊为乙肝肝硬化的1350例患者的临床资料,根据2015年国际腹水俱乐部所定义AKI的诊断标准,分为AKI组及非AKI组,根据变量类型,分别用χ^(2)检验、t检验及Mann-Whitney U检验比较两组的资料差异,用二元Logistic回归筛出AKI的危险因素,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC),评估各危险因素对发生AKI患者的诊断价值,分析终末期肝病模型对于乙肝肝硬化合并腹水患者发生AKI以及短期预后的预测价值。结果最终纳入的446例乙肝肝硬化合并腹水患者中发生AKI的有111例,多因素Logistic回归分析结果显示:凝血酶原活动度(OR=1.031,95%CI:1.005~1.058)、尿素氮(OR=1.305,95%CI:1.175~1.450)、终末期肝病模型(MELD)评分(OR=1.181,95%CI:1.100~1.267)、中量腹水(OR=7.218,95%CI:2.170~24.008)是乙肝肝硬化合并腹水患者发生AKI的独立危险因素(P<0.05)。ROC曲线中四者联合预测指标的曲线下面积(area under curve,AUC)值最大(AUC=0.895)。结论凝血酶原活动度、尿素氮、MELD评分、腹水严重程度是乙肝肝硬化合并腹水患者发生AKI的独立危险因素,四者联合建立的预测模型预测价值较高。Objective To explore the predictive factors of acute kidney injury(AKI)in patients with hepatitis B cirrhosis plus ascites and establish a new prediction model.Methods Fom January 1,2018 to December 31,2022,the relevant clinical data were retrospectively reviewed for 1350 patients with hepatitis B cirrhosis admitted into Department of Infection of First Affiliated Hospital of Xinjiang Medical University.According to the diagnostic criteria for AKI of International Ascites Club in 2015,they were divided into two groups of AKI and non-AKI.According to the types of variables,the data differences between two groups were compared byχ^(2),T and Mann-Whitney U.The risk factors for AKI were screened by binary Logistic regression and ROC curve was plotted for evaluating the diagnostic value of each risk factor for AKI.An end-stage liver disease model was utilized for predicting AKI and short-term outcomes.Results Among 446 patients with hepatitis B cirrhosis and ascites,111 cases developed AKI.The results of multivariate Logistic regression analysis revealed that prothrombin activity(OR=1.031,95%CI:1.005-1.058),blood urea nitrogen(BUN)(OR=1.305,95%CI:1.175-1.450),MELD score(OR=1.181,95%CI:1.100-1.267)and moderate ascites(OR=7.218,95%CI:2.170-24.008)were independent risk factors for AKI(P<0.05).In ROC curve,AUC value of four-party combined predictor was the greatest(AUC=0.895).Conclusion Prothrombin activity,BUN,MELD score and ascitic severity are independent risk factors for AKI in patients with hepatitis B cirrhosis plus ascites.And combined prediction model established by these four factors has a high predictive value.

关 键 词：乙型肝炎 腹水 急性肾损伤 危险因素 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学] R692