摘要
目的分析抗凝血酶Ⅲ活性联合慢性肝功能衰竭联盟—器官功能衰竭评分(CLIF-C OFs)对乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者预后的评估价值。方法选取2019年8月—2021年5月首都医科大学附属北京安贞医院急诊危重症中心收治HBV-ACLF患者243例,根据病情严重程度分为早期组(n=107)、中期组(n=63)、晚期组(n=73),并根据患者60 d预后情况分为死亡组(n=53)和存活组(n=190)。发色底物法检测患者入院时的抗凝血酶Ⅲ活性,并计算入院时的CLIF-C OFs评分。多因素Logistic回归分析HBV-ACLF患者预后不良的影响因素,ROC曲线分析抗凝血酶Ⅲ活性联合CLIF-C OFs评分对HBV-ACLF患者预后不良的评估价值。结果早期组、中期组、晚期组患者的抗凝血酶Ⅲ活性依次降低,CLIF-C OFs评分依次升高(H=195.003、139.852,P均<0.01)。与存活组比较,死亡组CLIF-C OFs评分、中性粒细胞比值、总胆红素、乙肝表面抗原(HBsAg)升高,抗凝血酶Ⅲ活性降低(Z/t=6.712、2.691、2.692、3.166、6.234,P=0.000、0.008、0.008、0.002、0.000)。高中性粒细胞比值、高HBsAg、高CLIF-C OFs评分为HBV-ACLF患者预后不良的独立危险因素[OR(95%CI)=1.048(1.005~1.092)、1.866(1.200~3.481)、2.850(2.011~4.039)],高抗凝血酶Ⅲ活性为独立保护因素[OR(95%CI)=0.848(0.785~0.917)]。抗凝血酶Ⅲ活性、CLIF-C OFs评分及二者联合评估HBV-ACLF患者预后不良的曲线下面积(AUC)为0.780、0.787、0.878,二者联合预测大于单独评估(Z=3.655、2.912,P=0.000、0.004)。结论抗凝血酶Ⅲ活性降低和CLIF-C OFs评分升高与HBV-ACLF患者病情加重和预后不良相关,抗凝血酶Ⅲ活性联合CLIF-C OFs评分能提升对HBV-ACLF患者预后不良的评估价值。
Objective To analyze the prognostic value of antithrombin Ⅲ activity combined with chronic liver failure alliance organ failure score(CLIF-C OFs)in patients with hepatitis B virus associated chronic plus acute liver failure(HBV-ACLF).Methods Two hundred and forty three patients with HBV-ACLF treated in the Emergency and Critical Care Unit of Beijing Anzhen Hospital Affiliated to Capital Medical University from August 2019 to may 2021 were selected.They were divided into early group(n=107),middle group(n=63)and late group(n=73)according to the severity of the disease.According to the 60 day prognosis,the patients were divided into death group(n=53)and survival group(n=190).The antithrombin Ⅲ activity was detected by chromogenic substrate method,and the CLIF-C OFs score was calculated.Multivariate logistic regression analysis was used to analyze the influencing factors of poor prognosis in patients with HBV-ACLF.ROC curve analysis was used to evaluate the value of antithrombin Ⅲ activity combined with CLIF-C OFs score in the evaluation of poor prognosis in patients with HBV-ACLF.Results The activity of antithrombin Ⅲ decreased in early group,middle group and late group,and the CLIF-C OFs score increased in turn(H=195.003,139.852,P<0.01).Compared with the survival group,the CLIF-C OFs score,neutrophil ratio,total bilirubin,hepatitis B surface antigen(HBsAg)increased and the activity of antithrombin Ⅲ decreased(Z/t=6.712,2.691,2.692,3.166,6.234,P=0.000,0.008,0.008,0.002,0)in the death group.High granulocyte ratio,high HBsAg and high CLIF-C OFs score were independent risk factors for poor prognosis in patients with HBV-ACLF[OR(95%CI)=1.048(1.005-1.092),1.866(1.200-3.481),2.850(2.011-4.039)],and high antithrombin Ⅲ activity was independent protective factor[OR(95%CI)=0.848(0.785-0.917)]The area under the curve(AUC)of antithrombin Ⅲ activity,CLIF-C OFs score and their combined evaluation of poor prognosis in patients with HBV-ACLF were 0.780,0.787 and 0.878.The combined prediction of antithrombin Ⅲ activ
作者
张蕾
贺建勋
范雪松
何立娟
闫树凤
崔颖
袁慧
Zhang Lei;He Jianxun;Fan Xuesong;He Lijuan;Yan Shufeng;Cui Ying;YuangHui(Clinical Laboratory,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;不详)
出处
《疑难病杂志》
CAS
2022年第1期36-40,45,共6页
Chinese Journal of Difficult and Complicated Cases
基金
国家自然科学基金资助项目(81902155)。
