摘要
目的:探讨血清可溶性甘露糖受体(sMR)联合终末期肝病模型(MELD)评分对乙型肝炎病毒(HBV)相关性慢加急性肝衰竭(ACLF)患者短期预后的评估价值。方法:选取176例HBV-ACLF患者,根据肝衰竭分期标准分为早期组(n=77)、中期组(n=46)、晚期组(n=53);根据12周内生存状况分为死亡组(n=68)和存活组(n=108)。收集患者一般资料和入院时血清sMR水平、MELD评分等实验室检查指标,对比不同病情HBV-ACLF患者血清sMR水平和MELD评分,单因素、多因素Logistics回归分析HBV-ACLF患者短期预后影响因素,ROC曲线分析血清sMR水平联合MELD评分对HBV-ACLF患者短期预后的评估价值。结果:早期组、中期组、晚期组患者血清sMR水平和MELD评分逐渐提升(P<0.05)。单因素分析显示,年龄、总胆固醇(TC)、中性粒细胞百分比(NEUT%)、总胆红素(TBil)、白蛋白(Alb)、甲胎蛋白(AFP)、乙型肝炎表面抗原(HBsAg)、sMR、MELD评分为HBV-ACLF患者短期预后影响因素(P<0.05)。多因素Logistics回归分析显示,NEUT%(OR=1.027,95%CI:0.985~1.071)、HBsAg(OR=1.117,95%CI:1.015~1.228)、sMR(OR=1.172,95%CI:1.096~1.252)、MELD评分(OR=1.245,95%CI:1.095~1.416)为HBV-ACLF患者短期预后独立危险因素,AFP(OR=0.988,95%CI:0.969~1.008)为独立保护因素(P<0.05)。ROC曲线显示,sMR+MELD评分评估HBV-ACLF患者短期预后的AUC为0.903,高于sMR、MELD评分单独评估(P<0.05)。结论:血清sMR水平和MELD评分与HBV-ACLF患者肝衰竭程度和短期预后密切相关,血清sMR水平联合MELD评分可提升HBV-ACLF患者短期预后评估价值。
Objective:To investigate the evaluation value of serum soluble mannose receptor(sMR)combined with a model of end-stage liver disease(MELD)score for the short-term prognosis of patients with hepatitis B virus(HBV)related acute-on-chronic liver failure(ACLF).Methods:A total of 176 HBV-ACLF patients was divided into an early group(n=77),middle group(n=46),and late group(n=53).According to the survival status within 12 weeks,they were divided into the death group(n=68)and the survival group(n=108).Collect the general data of patients and laboratory examination indicators such as serum sMR level and MELD score at admission,compare the serum sMR level and MELD score of HBV-ACLF patients with different conditions,and analyze the factors affecting the short-term prognosis of HBV-ACLF patients by univariate and multivariate Logistics regression.ROC curve analysis of serum sMR level combined with MELD score for the short-term prognosis of HBV-ACLF patients.Results:The serum sMR level and MELD score of patients in the early group,middle group,and late group gradually increased(P<0.05).Univariate analysis showed that age,total cholesterol(TC),neutrophil percentage(NEUT%),total bilirubin(TBil),albumin(ALB),alpha-fetoprotein(AFP),hepatitis B surface antigen(HBsAg),sMR,and MELD scores were influencing factors for the short-term prognosis of HBV-ACLF patients(P<0.05).Multivariate logistic regression analysis showed that NEUT%(OR=1.027,95%CI:0.985~1.071),HBsAg(OR=1.117,95%CI:1.015~1.228),sMR(OR=1.172,95%CI:1.096~1.252),MELD(OR=1.245,95%CI:1.095~1.416)score is an independent risk factor for short-term prognosis of HBV-ACLF patients,AFP(OR=0.988,95%CI:0.969~1.008)an independent protective factor(P<0.05).The ROC curve shows that AUC(0.903)of the sMR+MELD score in assessing the short-term prognosis of HBV-ACLF patients is slightly higher than that of sMR,MELD score evaluation(P<0.05).Conclusion:Serum sMR level and MELD score is closely related to the degree of liver failure and short-term prognosis of HBV-ACLF patients.The combinatio
作者
谢春燕
甘雪梅
朱芳成
李晓慧
XIE Chun-yan;GAN Xue-mei;ZHU Fang-cheng(Department of infection,Dazhou Central Hospital(Dazhou,Sichuan,635000),China)
出处
《中西医结合肝病杂志》
CAS
2022年第9期807-810,814,共5页
Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases
基金
四川省科技计划项目(No.17YYJC0122)。
关键词
乙型肝炎病毒
慢加急性肝衰竭
可溶性甘露糖受体
终末期肝病模型
短期预后
hepatitis B virus
acute-on-chronic liver failure
soluble mannose receptor
model of end-stage liver disease
short-term prognosis
