摘要
目的探索血清前白蛋白-总胆红素评分(PALBI)对血浆置换(PE)经治乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者短期预后的评估价值。方法选取福建医科大学孟超肝胆医院2020年1月至2021年12月接受3次以上PE治疗的112例HBV-ACLF患者,其中存活组77例,死亡组35例。分析两组基线特征,采用多因素分析患者预后的独立影响因素,并建立PALBI模型。通过受试者工作特征曲线(ROC)评价PALBI的区分度,并与终末期肝病模型(MELD)和白蛋白-胆红素(ALBI)评分进行比较。结果与存活组比较,死亡组合并肝性脑病(15.58%比48.57%,χ^(2)=11.980,P=0.001)、肝衰竭临床分期晚期患者(7.80%比37.14%,χ^(2)=14.021,P=0.001)的比例高,总胆红素水平高[364.07(287.05,427.95)比456.16(351.20,542.90),Z=-3.810,P<0.01],凝血酶原时间延长[22.61(18.40,24.75)比26.58(21.40,30.40),Z=-2.916,P=0.004],前白蛋白水平降低[51.23(37.50,62.50)比37.14(25.00,52.00),Z=-3.212,P=0.001]。多因素分析显示:总胆红素、前白蛋白是PE经治的HBV-ACLF患者短期预后不良的独立影响因素,总胆红素回归系数是0.011(95%CI:1.005~1.017;P<0.01),前白蛋白回归系数是-0.064(95%CI:0.903~0.975;P=0.001),建立PALBI=0.011×[TBil(μmol/L)]-0.064×[PAB(mg/L)]-1.848。PALBI ROC曲线下面积(AUC)=0.827(95%CI:0.747~0.908,P<0.01)、MELD AUC=0.710(95%CI:0.604~0.815,P<0.01)、ALBI评分AUC=0.726(95%CI:0.631~0.821,P<0.01),ROC曲线两两比较,PALBI与MELD对比,Z=2.470,P=0.014,PALBI与ALBI对比,Z=2.274,P=0.023,PALBI优于MELD和ALBI评分,差异有统计学意义(P<0.05)。结论PALBI对PE经治HBV-ACLF患者的短期预后具有一定的临床预测价值。
Objective To explore the value of serum prealbumin bilirubin score(PALBI)in evaluating the short-term prognosis of patients with hepatitis B virus-associated chronic acute liver failure(HBV-ACLF)treated with plasma exchanges(PE).Methods A total of 112 HBV-ACLF patients who received mutiple times(>3)of PE treatment were enrolled in this study.According to the clinical outcomes of patients,they were divided into two groups:a survival group and a death group.The difference of baseline characteristics between the two groups was analyzed and compared.The independent prognostic factors of patients post PE treatments were analyzed by multivariate analysis with an establishment of PALBI model.The differentiation of PALBI was evaluated by receiver operator characteristic curve(ROC)method.The model for end-stage liver disease model(MELD)and albumin-bilirubin(ALBI)scores of patients in each group were compared.Results Among the 112 cases of HBV-ACLF treated with PE,77 cases survived and 35 cases died.Compared with the survival group,the proportion of patients with hepatic encephalopathy in the death group[15.58%vs.48.57%(χ^(2)=11.980,P=0.001)]and the advanced stages of liver failure disease[in the early stage 27.27%vs.22.86%,in the middle stage 64.93%vs.40%,in the advanced stages 7.80%vs.37.14%(χ^(2)=14.021,P=0.001)]was higher,the total bilirubin level was higher[364.07(287.05,427.95)vs 456.16(351.20,542.90)(Z=-3.810,P<0.001)],the prothrombin time was longer[22.61(18.40,24.75),26.58(21.40,30.40)(Z=2.916,P=0.004)],and the prealbumin level was reduced[51.23(37.50,62.50),37.14(25.00,52.00)(Z=3.212,P=0.001)].Multivariate analysis showed that total bilirubin and prealbumin were independent influencing factors for the short-term poor prognosis of HBV-ACLF patients,The regression coefficient of total bilirubin was 0.011(95%CI:1.005~1.017;P<0.001),the regression coefficient of prealbumin was-0.064(95CI%:0.903~0.975;P=0.001),and the PALBI=0.011×[TBIL(μmol/L)]-0.064×[PAB(mg/L)]-1.848.The area under the curve(AUC)of ROC for the P
作者
陈丽霞
许镇额
刘海钰
林建辉
CHEN Li-xia;XU Zhen-e;LIU Hai-yu;LIN Jian-hui(Department of Critical Care Medicine,Mengchao Hepatobiliary Hospital of Fujian Medical University,Fuzhou 350001,China;Artificial Liver Center,Mengchao Hepatobiliary Hospital of Fujian Medical University,Fuzhou 350001,China;Union Medical College of Fujian Medical University,Fuzhou 350001,China)
出处
《肝脏》
2023年第7期794-798,共5页
Chinese Hepatology
基金
北京肝胆相照公益基金会人工肝专项基金(iGandanF-1082022-RGG003)
福建省自然科学基金(面上)项目(2021J011293)。
关键词
乙型肝炎病毒
慢加急性肝衰竭
血浆置换
模型
预后
Hepatitis B virus
Acute-on-chronic liver failure
Plasma exchange
PALBI model
Prognosis
