恩替卡韦治疗慢性乙型肝炎肝硬化停药后进展为肝衰竭的预后相关因素  

Prognostic factors related to liver failure after discontinuation of entecavir treatment in patients with chronic hepatitis B cirrhosis

作　　者：张秋霞 王燕燕 刘小青 ZHANG Qiuxia;WANG Yanyan;LIU Xiaoqing(Department of Infectious Diseases,the Third Hospital of Nanchang,Nanchang,Jiangxi,330009,China)

机构地区：[1]南昌市第三医院感染性疾病科,江西南昌330009

出　　处：《当代医学》2024年第36期138-141,共4页Contemporary Medicine

摘　　要：目的探讨恩替卡韦(entecavir,ETCV)治疗慢性乙型肝炎(chronic hepatitis B,CHB)肝硬化停药后进展为肝衰竭(liver failure,LF)的预后相关因素。方法选取2020年1月至2022年1月南昌市第三医院收治的70例采用ETCV治疗的CHB肝硬化停药后进展为LF的患者作为研究对象,根据患者预后分为存活组(n=34)与死亡组(n=36)。比较两组临床资料,采用多因素Logistic回归分析CHB肝硬化停药后进展为LF预后不良的独立危险因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线,并计算曲线下面积(area under the curve,AUC),探讨入院时终末期肝病模型(model for end-stage liver disease,MELD)评分预测患者死亡的效能。结果死亡组急性肾损伤占比、肝性脑病占比、总胆红素水平、血肌酐水平、国际标准化比值、入院时MELD评分均高于存活组,血小板计数低于存活组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,急性肾损伤、肝性脑病、入院时MELD评分是CHB肝硬化停药后进展为LF预后不良的独立危险因素(OR>1,P<0.05)。ROC曲线分析结果显示,入院时MELD评分预测患者死亡的AUC为0.953,最佳临界值为33分,灵敏度为88.9%,特异度为87.4%。结论急性肾损伤、肝性脑病及入院时MELD评分与ETCV治疗CHB肝硬化停药后进展LF的预后密切相关。Objective To investigate the prognostic factors related to liver failure(LF)after discontinuation of entecavir treatment in patients with chronic hepatitis B(CHB)cirrhosis.Methods A total of 70 patients with CHB progressing to liver failure after drug withdrawal who were treated with ETCV in the Third Hospital of Nanchang from January 2018 to October 2021 were selected as the study subjects,the patients were divided into the survival group(n=34)and the death group(n=36)according to the prognosis.The clinical data were compared between the two groups,multivariate Logistic regression analysis was used to explore the independent risk factors for the poor prognosis of LF after withdrawal of CHB cirrhosis,the receiver operating characteristic(ROC)curve was drawn,the area under the curve(AUC)was calculated to investigate the efficacy of model for end-stage liver disease(MELD)score at admission in predicting patient death.Results The proportions of acute kidney injury and hepatic encephalopathy,total bilirubin and serum creatinine levels,international normalized ratio and the MELD scores at admission in the death group were higher than those in the survival group,and platelet count was lower than that in survival group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that acute kidney injury,hepatic encephalopathy and MELD score were independent risk factors for poor prognosis of LF after withdrawal of CHB cirrhosis(OR>1,P<0.05).ROC curve analysis showed that the AUC,optimal cut-off value,sensitivity and specificity of MELD score at admission to predict death were 0.953,33 scores,88.9%and 87.4%,respectively.Conclusion Acute kidney injury,hepatic encephalopathy and MELD score on admission are closely related to the prognosis of LF progression after discontinuation of ETCV in the treatment of CHB cirrhosis.

关 键 词：慢性乙型肝炎 肝硬化 肝衰竭 预后 

分 类 号：R57[医药卫生—消化系统]