氯离子在肝硬化失代偿期患者预后中的角色  

Role of chloride ions in the prognosis of patients with decompensated cirrhosis

作　　者：田梦 欧阳晶 常虹 杨锦 刘敏[2] 王玉平[2] 陈兆峰[2] Meng Tian;Jing Ouyang;Hong Chang;Jin Yang;Min Liu;Wang Yuping;Chen Zhaofeng(The First Clinical Medical College of Lanzhou University;Department of Gastroenterology,The First Hospital of Lanzhou University)

机构地区：[1]兰州大学第一临床医学院,兰州730000 [2]兰州大学第一医院消化科,兰州730000

出　　处：《重庆医科大学学报》2025年第3期367-375,共9页Journal of Chongqing Medical University

基　　金：甘肃省联合科研基金重大资助项目(编号:23JRRA1487)。

摘　　要：目的:探究血清氯离子浓度对危重症和临床病情稳定的肝硬化失代偿期患者的预后价值。方法:回顾性纳入2017年1月至2022年1月于兰州大学第一医院重症医学科(intensive care unit,ICU)和消化科就诊的肝硬化失代偿期患者。分为ICU组和消化科组;ICU组终点事件是院内死亡,logistic回归分析血清氯化物水平与ICU死亡率之间的关系,采用受试者工作特征曲线,并计算曲线下面积(area under the curve,AUC)评估血氯水平对ICU死亡率的预测价值。对纳入的消化科患者随访,终点事件是患者全因死亡率,运用Cox回归分析和Kaplan-Meier分析,探讨血氯水平对于患者死亡率的预测价值。结果:ICU组中:血清氯离子与ICU院内死亡率明显相关(OR=0.934,95%CI=0.871~0.993,P=0.035),血氯预测ICU院内死亡率AUC值为0.687;消化科组:在Child-Pugh评分<10的亚组中,血清氯离子浓度与患者死亡率明显相关(HR=0.906,95%CI=0.822~0.997,P=0.043),低氯血症与更低的生存率相关。结论:低氯血症与肝硬化失代偿期患者的死亡率增加相关。Objective:To investigate the prognostic value of serum chloride ion concentration in critically ill or clinically stable patients with decompensated cirrhosis.Methods:A retrospective study was conducted among the patients with decompensated cirrhosis who attended the intensive care unit(ICU)and Department of Gastroenterology,The First Hospital of Lanzhou University,from January 2017 to January 2022,and the patients were divided into ICU cohort and Gastroenterology cohort.The outcome event for the ICU cohort was in-hospital death.A logistic regression analysis was used to investigate the association between serum chloride levels and ICU mortality rate;the receiver operating characteristic(ROC)curve was plotted and the area under the ROC curve(AUC)was calculated to assess the value of blood chloride level in predicting ICU mortality rate.The patients in the Gastroenterology cohort were followed up with the outcome event of all-cause mortality rate,and the Cox regression analysis and the Kaplan-Meier analysis were used to investigate the value of blood chloride level in predicting mortality rate.Results:In the ICU cohort,serum chloride ion was significantly associated with in-hospital mortality in the ICU(odds ratio=0.934,95%CI=0.871-0.993,P=0.035),and blood chlorine had an AUC of 0.687 in predicting in-hospital mortality in the ICU.In the Gastroenterology cohort,serum chloride ion concentration was significantly associated with mortality rate in the subgroup with a Child-Pugh score of<10(hazard ratio=0.906,95%CI=0.822-0.997,P=0.043),and hypochloremia was associated with a lower survival rate.Conclusion:Hypochloremia is associated with the increase in mortality rate in patients with decompensated cirrhosis.

关 键 词：肝硬化 预后 血清钠离子 血清氯离子 

分 类 号：R575.2[医药卫生—消化系统]