中国重症乙型肝炎研究学组-慢加急性肝衰竭Ⅱ评分联合血清甲胎蛋白评估人工肝治疗乙型肝炎病毒相关慢加急性肝衰竭患者预后的价值  

Value of Chinese Group on the Study of Severe Hepatitis B-acute-on-chronic liver failure Ⅱ score combined with serum alpha-fetoprotein in evaluating the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure treated with artificial liver therapy

作　　者：赵昱博 马艳波[1] 王依泊 黄彤[2] Zhao Yubo;Ma Yanbo;Wang Yibo;Huang Tong(Department of Hepatobiliary and Pancreatic Surgery,The First Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Infectious Diseases,The First Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第一医院肝胆胰外科及肝脏移植中心,太原030001 [2]山西医科大学第一医院感染病科,太原030001

出　　处：《中华传染病杂志》2024年第8期455-462,共8页Chinese Journal of Infectious Diseases

基　　金：北京肝胆相照公益基金会(iGandanF-1082023-RGG010)。

摘　　要：目的探讨中国重症乙型肝炎研究学组-慢加急性肝衰竭(COSSH-ACLF Ⅱ)评分联合血清甲胎蛋白(AFP)预测人工肝治疗乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者预后的价值。方法纳入2023年3月至2024年4月山西医科大学第一医院感染病科收治的初次进行人工肝治疗的174例HBV-ACLF患者。计算终末期肝病模型(MELD)、终末期肝病模型联合血清钠(MELD-Na)、MELD 3.0及COSSH-ACLF Ⅱ评分。将174例患者按照7∶3的比例分为训练集和验证集。根据随访的生存结局分别将训练集和验证集中的患者分为生存组与死亡组, 比较两组实验室检查、血清AFP水平及各模型评分。采用logistic回归分析HBV-ACLF患者预后的影响因素并建立列线图模型。采用受试者操作特征曲线(ROC曲线)评估COSSH-ACLF Ⅱ评分联合血清AFP水平对HBV-ACLF患者随访截止时(2024年6月14日)的预后及人工肝术后30、60、90 d生存结局的预测价值。统计学比较采用独立样本t检验、曼-惠特尼U检验。结果 174例HBV-ACLF患者中, 训练集122例(存活80例, 死亡42例), 验证集52例(存活17例, 死亡35例)。训练集中死亡组患者的年龄、中性粒细胞计数、尿素、MELD评分、MELD-Na评分、MELD 3.0评分、COSSH-ACLF Ⅱ评分及AFP水平均高于生存组, 差异均有统计学意义(t=2.82、Z=-3.27、Z=-2.65、t=2.16、t=2.60、t=2.33、t=4.56、Z=-4.71, 均P<0.05)。验证集中, 死亡组白蛋白、COSSH-ACLF Ⅱ评分及AFP水平均高于生存组, 差异均有统计学意义(Z=-2.20、t=2.78、Z=-2.55, 均P<0.05)。血清AFP [比值比(OR)=1.005, 95%可信区间(95%CI) 1.001~1.008,P=0.010]、COSSH-ACLF Ⅱ评分(OR=2.140, 95%CI 1.410~3.240, P<0.001)是HBV-ACLF患者预后的独立危险因素。构建AFP和COSSH-ACLF Ⅱ评分预测HBV-ACLF患者预后的列线图, 其C指数为0.816, 校准曲线拟合良好。训练集中COSSH-ACLF Ⅱ评分、血清AFP水平和两者联合预测患者预后的曲线下面积(AUC)分别Objective:To explore the value of Chinese Group on the Study of Severe Hepatitis B-acute-on-chronic live failure(COSSH-ACLFⅡ)score combined with serum alpha-fetoprotein(AFP)in predicting the prognosis of hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF)patients treated with artificial liver therapy.Methods:A total of 174 HBV-ACLF patients who underwent initial artificial liver therapy admitted to the Department of Infectious Diseases,The First Hospital of Shanxi Medical University,from March 2023 to April 2024 were enrolled.The model for end-stage liver disease(MELD),MELD combined with serum sodium(MELD-Na),MELD 3.0,and COSSH-ACLFⅡscores were calculated.The 174 patients were divided into a training set and a validation set at a 7∶3 ratio.Based on follow-up survival outcomes,the patients in the training and validation sets were classified into survival and non-survivor groups.Laboratory tests,serum AFP levels,and various model scores were compared between the two groups.Logistic regression analysis was used to identify prognostic factors in HBV-ACLF patients,and a nomogram model was constructed.The predictive value of COSSH-ACLFⅡscore combined with serum AFP levels for follow-up deadline(June 14,2024)prognosis and survival outcomes at 30,60,and 90 days post-artificial liver therapy in HBV-ACLF patients was assessed using receiver operating characteristic(ROC)curves.Statistical comparisons were performed using the independent sample t test and Mann-Whitney U test.Results:Among the 174 HBV-ACLF patients,122 were in the training set(80 survivors,42 non-survivors)and 52 were in the validation set(17 survivors,35 non-survivors).In the training set,age,neutrophil count,urea,MELD score,MELD-Na score,MELD 3.0 score,COSSH-ACLFⅡscore,and AFP levels in the non-survivor group were significantly higher than those in the survivor group(t=2.82,Z=-3.27,Z=-2.65,t=2.16,t=2.60,t=2.33,t=4.56 and Z=-4.71,respectively,all P<0.05).In the validation set,albumin,COSSH-ACLFⅡscore,and AFP levels in the non-su

关 键 词：甲胎蛋白类 中国重症乙型肝炎研究学组-慢加急性肝衰竭Ⅱ评分 肝 人工 预后 

分 类 号：R512.62[医药卫生—内科学]