评估系统性炎症标志物与慢加急性肝衰竭患者预后的关系  

To evaluate the relationship between markers of systemic inflammation and prognosis in patients with acute-on-chronic liver failure

作　　者：刘大晴 蔡雯 甘建和[1] 黄燕[1] LIU Daqing;CAI Wen;GAN Jianhe;HUANG Yan(Department of Infectious Diseases,the First Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属第一医院感染科,江苏苏州215000

出　　处：《胃肠病学和肝病学杂志》2025年第4期567-574,共8页Chinese Journal of Gastroenterology and Hepatology

基　　金：“十三五”国家科技重大专项项目(2017ZX10203201002-002);2023年度人工肝专项基金(iGandanF-1082023-RGG011);吴阶平医学基金会科研专项资助基金(320.6750.2025-01-9)。

摘　　要：目的探讨系统性炎症标志物与慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)患者预后的关系。方法回顾性分析2019年12月至2023年12月在苏州大学附属第一医院感染科住院治疗的ACLF患者(n=301)和ACLF前期患者(n=75),另选取同期60名健康体检者作为对照,收集患者入院当天临床信息和实验室指标,计算中性粒细胞与淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)、单核细胞与淋巴细胞比值(monocyte/lymphocyte ratio,MLR)、血小板与淋巴细胞比值(platelet to lymphocyte ratio,PLR)、C反应蛋白与白蛋白比值(C-reactive protein/albumin ratio,CAR)、C反应蛋白与淋巴细胞比值(C-reactive protein to lymphocyte ratio,CLR)、全身免疫炎症指数(systemic immune-inflammation index,SII)、系统炎症反应指数(systemic inflammatory index,SIRI)。根据ACLF患者28 d生存情况分为生存组和死亡组,根据ACLF病因不同,将患者分为乙肝组和非乙肝组。根据ACLF诊断标准将患者进一步分为早期、中期和晚期。结果以ACLF患者28 d死亡作为因变量,经过单因素Logistic回归分析及LASSO算法筛选变量,结果显示CAR、NLR、COSSH-ACLFⅡs为ACLF患者预后的独立危险因素,并以CAR、NLR、COSSH-ACLFⅡs为自变量拟合二元Logistic预后模型CCN并绘制Nomogram。结论CAR、NLR、模型CCN、COSSH-ACLFⅡs为ACLF患者预后的独立危险因素,并且CAR对ACLF预后预测效能优于NLR,模型CCN对ACLF预后预测效能优于CAR、NLR、COSSH-ACLFⅡs。Objective To investigate the relationship between systemic inflammatory markers and prognosis in patients with acute-on-chronic liver failure(ACLF).Methods Retrospective analysis was performed on 301 patients with ACLF and 75 patients with pre-ACLF who were hospitalized in the Department of Infectious Diseases,the First Affiliated Hospital of Soochow University from Dec.2019 to Dec.2023.Another 60 healthy subjects were selected as control group.Clinical information and laboratory indicators were collected on the day of admission.Neutrophil to lymphocyte ratio(NLR),monocyte to lymphocyte ratio(MLR),platelet to lymphocyte ratio(PLR),C-reactive protein to albumin ratio(CAR),C-reactive protein to lymphocyte ratio(CLR),systemic immunoinflammatory index(SII),and systemic inflammatory response index(SIRI)were calculated.ACLF patients were divided into survival group and death group according to their 28-day survival.According to the different causes of ACLF,the patients were divided into hepatitis B group and non-hepatitis B group.According to the diagnostic criteria of ACLF,the patients were further divided into early,middle and late stages.Results The 28 day death of ACLF patients was taken as the dependent variable,and after univariate Logistic regression analysis and LASSO algorithm screening variables,the results showed that CAR,NLR and COSSH-ACLFⅡs were independent risk factors for prognosis of ACLF patients.CAR,NLR and COSSH-ACLFⅡs were used as independent variables to fit the binary Logistic prognostic model CCN and draw Nomogram.Conclusion CAR,NLR,model CCN and COSSH-ACLFⅡs are independent risk factors for the prognosis of ACLF patients.Furthermore,CAR demonstrates superior predictive efficacy for ACLF prognosis compared to NLR,while model CCN exhibits higher predictive performance than CAR,NLR and COSSH-ACLFⅡs.

关 键 词：慢加急性肝衰竭 C反应蛋白与白蛋白比值 预后 系统性炎症标志物 

分 类 号：R575[医药卫生—消化系统]