NLR+iMELD对乙型肝炎慢加急性肝衰竭患者预后的评估价值  

Prognosis Value of NLR+iMELD in Hepatitis B Virus(HBV)-Related Acute-on-Chronic Liver Failure

作　　者：钱珍[1] 辛雪萍 张威 张帆 王帅[1] QIAN Zhen;XIN Xueping;ZHANG Wei;ZHANG Fan;WANG Shuai(The First Affiliated Hospital,College of Clinical Medicine of Henan University of Science and Technology,Luoyang,China,471003;Department of Gastroenterology,The Third Affiliated Hospital of Henan University of Science and Technology,Luoyang,China,471003)

机构地区：[1]河南科技大学临床医学院,河南科技大学第一附属医院,洛阳471003 [2]河南科技大学第三附属医院消化内科,洛阳471003

出　　处：《西南医科大学学报》2025年第2期206-209,共4页Journal of Southwest Medical University

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20191256);洛阳市科技计划项目(1970001A);佑安肝病感染病专科医疗联盟科研专项经费资助项目(LM202007)。

摘　　要：目的探讨中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)联合终末期肝病血清钠年龄模型(Integrated Model for End-stage Liver Disease,iMELD)对乙型肝炎慢加急性肝衰竭(hepatitis B virus-related acute-on-chronic liver failure,HBV-ACLF)预后的评估价值。方法分析126例HBV-ACLF患者,根据90 d的预后情况将患者分为生存组(72例)和死亡组(54例)。收集患者入院时的肝功能、血肌酐、凝血常规、血清钠离子、血常规等并记录年龄、性别等。根据各自的相关指标计算出NLR、iMELD值。采用多因素Logistic回归分析各评分系统与HBV-ACLF患者疾病转归的关系,通过绘制受试者工作特征(ROC)曲线分析NLR+iMELD的ROC曲线下面积(AUC),分析NLR+iMELD评分与HBV-ACLF患者预后的相关性。结果HBV-ACLF患者死亡组的NLR、iMELD评分(3.507±0.726、43.13±7.58)均高于生存组(2.850±0.557、34.08±8.41),差异具有统计学意义(P<0.001)。NLR的AUC为0.745(95%CI:0.657~0.833);iMELD的AUC为0.792(95%CI:0.714~0.870);NLR+iMELD的AUC相对最高,为0.865(95%CI:0.800~0.930)。结论NLR+iMELD对HBV-ACLF患者的预后具有较好的评估价值和临床指导意义。Objective To investigate the prognostic value of the neutrophil-to-lymphocyte ratio(NLR)combined with the inte⁃grated model for end-stage liver disease incorporating serum sodium and age(iMELD)in assessing the prognosis of hepatitis B virusrelated acute-on-chronic liver failure(HBV-ACLF).Methods A total of 126 HBV-ACLF patients were analyzed and divided into a survival group(72 cases)and a death group(54 cases)based on their 90-day prognosis.Upon admission to the hospital,liver function tests,serum creatinine levels,coagulation profiles,serum sodium ion levels,and complete blood counts were collected,and the patients'age and gender were recorded.The Neutrophil-to-Lymphocyte Ratio(NLR)and Model for End-stage Liver Disease(MELD)scores were calculated based on the relevant indicators.Multivariate logistic regression was used to analyze the relationship between each scoring system and the disease outcome of HBV-ACLF patients.Receiver operating characteristic(ROC)curves were plotted to analyze the area under the ROC curve(AUC)for NLR+iMELD,examining the correlation between NLR+iMELD scores and the prognosis of HBV-ACLF patients.Results The NLR,iMELD scores in the death group of HBV-ACLF patients were(3.507±0.726,43.13±7.58),respectively,all higher than those in the survival group(2.850±0.557,34.08±8.41)(P<0.001).The AUC indi⁃cated that the AUC for NLR was 0.745(95%CI:0.657~0.833);for iMELD,it was 0.792(95%CI:0.714~0.870);and the com⁃bined NLR+iMELD had the highest AUC at 0.865(95%CI:0.800~0.930).Conclusion The NLR+iMELD showed significant prognostic value and clinical guidance for patients with HBV-ACLF.

关 键 词：慢加急性肝衰竭 预后评估 中性粒细胞与淋巴细胞比值 终末期肝病血清钠年龄模型 

分 类 号：R575[医药卫生—消化系统]