PTAAR在乙肝相关慢加急性肝衰竭患者短期预后中的预测价值  

Predictive value of PTAAR for short-term prognosis of patients with hepatitis B virus-related acuteon-chronic liver failure

作　　者：关小玲 周文营[1] 陈洪平[1] Guan Xiaoling;Zhou Wenying;Chen Hongping(Clinical Laboratory,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院检验科,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2024年第6期841-845,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省医学科学技术研究基金(B2023492)

摘　　要：目的探讨凝血酶原活动度与白蛋白比值(PTAAR)在乙型病毒性肝炎(乙肝)相关慢加急性肝衰竭(ACLF)患者短期预后中的预测价值。方法回顾性分析2019年至2020年在中山大学附属第三医院住院治疗的286例ACLF患者临床资料。研究符合医学伦理学规定。其中男243例,女43例;年龄19~75岁,中位年龄46岁。对患者进行3个月的生存随访,将患者分为生存组(238例)和死亡组(48例)。收集患者一般资料、生化、凝血功能等指标,进行Logistic回归分析,筛选ACLF患者预后的影响因素,基于PTAAR构建ACLF预测模型。采用ROC曲线分析PTAAR模型的预测价值。结果乙肝相关慢加急性肝衰竭患者3个月内病死率为16.8%(48/286)。Logistic多因素回归分析显示,年龄、TB、PTAAR是ACLF患者短期预后的独立影响因素(OR=1.058,1.003,0.212;P<0.05)。基于PTAAR建立ACLF患者短期预后的预测模型,=-4.365+0.077×Age+0.003×TB-1.813×PTAAR。PTAAR模型的ROC曲线下面积为0.782(95%CI:0.711~0.853),明显大于MELD评分的0.671(95%CI:0.583~0.758)(Z=2.381,P<0.05)。基于PTAAR的模型和MELD评分的截断值分别为0.133、22.886,敏感度分别为0.854、0.792,特异度分别为0.601、0.529。结论乙肝相关ACLF患者3个月内病死率较高,PTAAR为ACLF患者3个月预后的预测因子,基于PTAAR构建的预测模型可获得较高的预测性能。Objective To evaluate the predictive value of prothrombin activity-to-albumin ratio(PTAAR)for the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure(ACLF).Methods Clinical data of 286 ACLF patients admitted to the Third Affiliated Hospital of Sun Yat-sen University from 2019 to 2020 were retrospectively analyzed.The local ethical committee approval was received.Among them,243 patients were male and 43 female,aged 19-75 years,with a median age of 46 years.The patients received 3-month follow-up.All patients were divided into the survival group(n=238)and death group(n=48).General data,biochemical parameters and coagulation function of patients were collected.The influencing factors of clinical prognosis of ACLF patients were screened by Logistic regression analysis.ACLF prediction model was constructed based on PTAAR.The predictive value of PTAAR model was evaluated by using the receiver operating characteristic(ROC)curve.Results The 3-month mortality rate of ACLF patients was 16.8%(48/286).Multivariate Logistic regression analysis showed that age,total bilirubin(TB)and PTAAR were the independent factors affecting the short-term prognosis of ACLF patients(OR=1.058,1.003,0.212;P<0.05).The prediction model for short-term prognosis of ACLF patients was established based on PTAAR:Logit(P)=-4.365+0.077×Age+0.003×TB-1.813×PTAAR.The area under the ROC curve(AUC)of PTAAR model was 0.782(95%CI:0.711-0.853),significantly larger than 0.671(95%CI:0.583-0.758)of MELD score(Z=2.381,P<0.05).The cutoff values of the model based on PTAAR and MELD score were 0.133 and 22.886,and 0.854 and 0.792 for the sensitivity,and 0.601 and 0.529 for the specificity,respectively.Conclusions The 3-month mortality rate of patients with hepatitis B-related ACLF is relatively high.PTAAR is a predictor for the 3-month prognosis of patients with ACLF.The prediction model based on PTAAR can achieve higher prediction performance.

关 键 词：肝功能衰竭 凝血酶原活动度与白蛋白比值 终末期肝病模型 预后 

分 类 号：R575.3[医药卫生—消化系统]