IL-6联合终末期肝病模型评分对HBV相关慢加急性肝衰竭预后的预测价值
DOI: 10.3969/j.issn.1001-5256.2022.08.011
Value of interleukin-6 combined with Model for End-Stage Liver Disease score in predicting the prognosis of hepatitis B virus-related acute-on-chronic liver failure
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摘要:
目的 探讨IL-6联合终末期肝病模型(MELD)评分对HBV相关慢加急性肝衰竭(HBV-ACLF)患者预后的预测价值。 方法 选取2015年1月—2018年12月于苏州大学附属第一医院住院的86例HBV-ACLF患者,根据随访90 d的生存情况分为死亡组(n=50)和存活组(n=36)。采用ELISA法测定血清IL-6水平,统计患者的一般资料。符合正态分布的计量资料两组间比较采用t检验,不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验;分类计数资料两组间比较采用χ2检验。IL-6与其他变量行Pearson相关性分析,采用二元logistic回归分析影响HBV-ACLF患者预后的独立危险因素,利用ROC曲线评价IL-6联合MELD评分对HBV-ACLF预后的预测价值。 结果 死亡组与存活组红细胞比积(Hct)(t=2.413)、PLT(t=6.584)、TBil(t=-8.070)、PT(U=77.500)、国际标准化比值(INR)(U=102.000)、HBV DNA(t=-2.767)、IL-6(t=-16.543)、MELD评分(t=-8.192)组间差异有统计学意义(P值均<0.05);死亡组IL-6水平高于存活组[(27.13±12.18) pg/mL vs (9.72±5.56) pg/mL,P < 0.001]。Pearson相关性分析结果显示,IL-6与TBil、PT呈显著正相关(r值分别为0.579、0.681,P值均<0.001)。运用二元logistic回归分析结果显示,IL-6(OR=1.480,95%CI:1.196~1.833,P=0.007)、MELD评分(OR=1.128,95%CI:1.033~1.231,P < 0.001)是HBV-ACLF患者90 d死亡的独立预测因子。IL-6联合MELD评分模型的AUC(AUC=0.891,95%CI: 0.778~0.999)高于IL-6(AUC=0.838,95%CI: 0.687~0.989)、MELD评分(AUC=0.783,95%CI: 0.634~0.933)。IL-6联合MELD评分模型对HBV-ACLF预后的预测价值高于IL-6(Z=-2.257,P=0.024)。 结论 IL-6联合MELD评分模型可作为评估HBV-ACLF患者短期预后较好的预测模型。 Abstract:Objective To investigate the value of interleukin-6 (IL-6) combined with Model for End-stage Liver Disease (MELD) score in predicting the prognosis of patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (HBV-ACLF). Methods A total of 86 patients with HBV-ACLF who were hospitalized in The First Affiliated Hospital of Soochow University from January 2015 to December 2018 were enrolled, and according to their survival status after follow-up for 90 days, they were divided into death group with 50 patients and survival group with 36 patients. ELISA was used to measure the serum level of IL-6, and a statistical analysis was performed for general information. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. A Pearson correlation analysis was performed for IL-6 and other variables; a binary logistic regression analysis was used to investigate the independent risk factors for the prognosis of patients with HBV-ACLF; the receiver operating characteristic (ROC) curve was used to assess the value of IL-6 combined with MELD score in predicting the prognosis of HBV-ACLF. Results There were significant differences between the death group and the survival group in hematocrit (t=2.413), platelet count (t=6.584), total bilirubin (TBil) (t=-8.070), prothrombin time (PT) (U=77.500), international standardized ratio (U=102.000), HBV DNA (t=-2.767), IL-6 (t=-16.543), and MELD score (t=-8.192), and the death group had a significantly higher level of IL-6 than the survival group (27.13±12.18 pg/mL vs 9.72±5.56 pg/mL, P < 0.001). The Pearson correlation analysis showed that IL-6 was positively correlated with TBil and PT (r=0.579 and 0.681, both P < 0.001). The binary logistic regression analysis showed that IL-6 (odds ratio[OR]=1.480, 95% confidence interval [CI]: 1.196~1.833, P=0.007) and MELD score (OR=1.128, 95%CI: 1.033~1.231, P < 0.001) were independent risk factors for the death of HBV-ACLF patients within 90 days. IL-6 combined with MELD score had an area under the ROC curve (AUC) of 0.891 (95%CI: 0.778~0.999), with a higher AUC than IL-6 (AUC=0.838, 95%CI: 0.687~0.989) or MELD score (AUC=0.783, 95%CI: 0.634~0.933). IL-6 combined with MELD score had a significantly higher value than IL-6 alone in predicting the prognosis of patients with HBV-ACLF (Z=-2.257, P=0.024). Conclusion IL-6 combined with MELD score can be used as a good model for predicting the short-term prognosis of patients with HBV-ACLF. -
Key words:
- Hepatitis B Virus /
- Acute-On-Chronic Liver Failure /
- Prognosis
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表 1 两组患者一般资料比较
Table 1. Comparison of general data between the two groups
指标 死亡组(n=50) 存活组(n=36) 统计值 P值 男性[例(%)] 32(64.00) 28(77.78) χ2=0.624 0.498 年龄(岁) 50.76±11.26 53.52±12.36 t=0.427 0.649 WBC(×109/L) 6.85±2.07 7.13±2.28 t=0.564 0.574 Hct(%) 0.38±0.06 0.41±0.07 t=2.413 0.018 PLT(×109/L) 72.68±13.65 91.70±16.73 t=6.584 <0.001 TBil(μmol/L) 344.70±37.58 282.63±50.08 t=-8.070 <0.001 ALT(U/L) 629.51±146.54 577.34±113.26 t=-1.539 0.293 AST(U/L) 637.26±157.49 523.04±127.86 t=-3.457 0.346 Alb(g/L) 31.56±2.74 34.64±3.37 t=0.952 0.344 SCr(μmol/L) 76.35(69.65~88.78) 72.50(61.15~81.80) U=601.500 0.349 PT(s) 31.80(25.15~33.10) 26.40(25.15~27.25) U=77.500 <0.001 INR 2.45(2.13~2.80) 1.70(1.60~1.85) U=102.000 <0.001 HBV DNA(×107IU/mL) 2.54±0.59 2.39±0.59 t=-2.767 0.006 IL-6(pg/mL) 27.13±12.18 9.72±5.56 t=-16.543 <0.001 MELD评分 27.15±3.48 22.54±2.85 t=-8.192 <0.001 表 2 HBV-ACLF患者预后相关因素分析
Table 2. Analysis of prognosis-associated factors in HBV-ACLF patients
指标 单因素分析 多因素分析 OR 95%CI P值 OR 95%CI P值 年龄 0.994 0.955~1.035 0.774 性别 0.958 0.396~2.317 0.925 WBC 0.945 0.772~1.157 0.585 Hct <0.001 0~0.246 0.024 <0.001 0~0.306 0.057 PLT 0.938 0.896~0.982 <0.001 0.923 0.874~0.975 0.254 TBi 1.032 1.015~1.050 <0.001 1.007 0.966~1.050 0.752 ALT 0.979 0.953~1.005 0.117 AST 1.021 0.994~1.049 0.128 Alb 0.921 0.784~1.081 0.314 SCr 0.976 0.940~1.013 0.201 PT 2.941 1.815~4.764 <0.001 1.676~7.976 0.067 INR 740.685 40.543~13 531.609 <0.001 737.956 39.347~15 051.320 0.493 HBV DNA 2.074 1.168~3.682 0.013 0.706 0.281~1.778 0.460 IL-6 1.150 1.066~1.240 <0.001 1.480 1.196~1.833 0.007 MELD评分 1.584 1.311~1.915 0.001 1.128 1.033~1.231 <0.001 -
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