| 摘要: |
| 目的 探讨青年HBV相关慢加急性肝衰竭（ACLF）预后的危险因素，并建立预后模型。方法 回顾性纳入2019年1月至2021年3月重庆医科大学附属第二医院及重庆医科大学附属大足医院感染科青年（15~44岁）HBV-ACLF患者113例，根据临床结局分为死亡组（64例）和存活组（49例）。通过单因素分析筛选出两组间差异有统计学意义的临床指标，纳入多因素二元logistic回归分析确定青年HBV-ACLF患者预后的独立危险因素并以此建立预后模型，采用ROC曲线评价模型预测价值。结果 113例患者总病死率为56.64%（64/113）。单因素分析显示，白细胞计数、中性粒细胞百分比、白蛋白、血钾、血钠、凝血酶原时间、国际标准化比值、肌酸激酶同工酶、降钙素原、甲胎蛋白、HBV-DNA定量及乙型肝炎e抗原定量水平可能影响HBV-ACLF患者的预后（P均＜0.05）。多因素二元logistic回归分析显示，HBV-DNA定量≥1×106 IU/mL（OR＝19.85，95% CI 1.64~239.84，P＜0.05）、低白蛋白（OR＝0.71，95% CI 0.53~0.96，P＜0.05）和低甲胎蛋白（OR＝0.58，95% CI 0.42~0.81，P＜0.05）是青年HBV-ACLF患者预后的独立危险因素。以此建立的预后模型为P预后＝1/（1+e－X），其中X＝5.82+2.99×HBV-DNA定量（≥1×106 IU/mL为1，＜1×106 IU/mL为0）－0.35×白蛋白（g/L）－0.54×甲胎蛋白（ng/mL），该模型预测青年HBV-ACLF预后的ROC AUC值为0.98（95% CI 0.97~1.00，P＜0.001）。结论 血清白蛋白、甲胎蛋白及HBV-DNA定量是青年HBV-ACLF预后的独立危险因素，基于此建立的预后模型预测价值较高，可为青年HBV-ACLF患者提前进行肝移植准备提供参考依据。 |
| 关键词: 乙型肝炎病毒 慢加急性肝衰竭 青年 预后 危险因素 |
| DOI：10.16781/j.CN31-2187/R.20211188 |
| 投稿时间：2021-11-24修订日期：2022-02-21 |
| 基金项目:重庆市大足区基础研究与前沿探索、技术预见与制度创新项目(DZKJ-2021ACC1021),重庆市医学高端后备人才培养项目 |
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| Prognostic risk factor analysis and prognostic model establishment of hepatitis B virus-related acute-on-chronic liver failure in young patients |
| WU Jing1,LIU He-lei1,XIA Hong1,YANG Qiang1,SHI Zhi-peng1,DENG Min1,LEI Yu2* |
(1. Department of Infectious Diseases, Dazu Hospital of Chongqing Medical University, The People's Hospital of Dazu, Chongqing 402360, China;
2. Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
*Corresponding author) |
| Abstract: |
| ObjectiveTo explore the prognostic risk factors for young patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) and establish a prognostic model.MethodsA total of 113 young patients (15-44 years old) with HBV-ACLF who were admitted to Department of Infectious Diseases of The Second Affiliated Hospital and Dazu Hospital of Chongqing Medical University from Jan. 2019 to Mar. 2021 were enrolled, and were divided into death group (n＝64) and survival group (n＝49) according to the outcomes. The clinical indexes with significant differences between the 2 groups were screened out by univariate analysis, and the independent risk factors of the prognosis of young HBV-ACLF patients were determined by multivariate binary logistic regression analysis. The prognostic model was established based on the risk indexes, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the model.ResultsThe total fatality of 133 patients was 56.64% (64/113). Univariate analysis showed that white blood cell count, percentage of neutrophil, albumin, serum potassium, serum sodium, prothrombin time, international standardized ratio, creatine kinase isoenzyme, procalcitonin, α-fetoprotein, HBV-DNA level and hepatitis B e antigen level might affect the prognosis of young patients with HBV-ACLF (all P < 0.05). Multivariate binary logistic regression analysis showed that HBV-DNA level≥1×106 IU/mL (odds ratio [OR]＝19.85, 95% confidence interval [CI] 1.64-239.84, P < 0.05), low albumin (OR＝0.71, 95% CI 0.53-0.96, P < 0.05) and low α-fetoprotein (OR＝0.58, 95% CI 0.42-0.81, P < 0.05) were independent risk factors of the prognosis of HBV-ACLF in young patients. The prognosis model was Pprognosis＝1/(1+e－X), where X＝5.82+2.99×HBV-DNA level (≥1×106 IU/mL was 1, < 1×106 IU/mL was 0)－0.35×albumin (g/L)－0.54×α-fetoprotein (ng/mL), and the area under ROC curve of this model for predicting the prognosis of HBV-ACLF in young patients was 0.98 (95% CI 0.97-1.00, P < 0.001).ConclusionSerum albumin, α-fetoprotein and HBV-DNA level are the independent risk factors of the prognosis of HBV-ACLF in young patients, and the established prognostic model has high predictive value and can provide reference for the preparation of liver transplantation in young HBV-ACLF patients. |
| Key words: hepatitis B virus acute-on-chronic liver failure youth prognosis risk factors |
