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年龄和D-二聚体联合终末期肝病模型对HBV相关慢加急性肝衰竭患者预后的预测价值

董少雨 孙长宇 乔芳芳 刘笑 张建营

引用本文:
Citation:

年龄和D-二聚体联合终末期肝病模型对HBV相关慢加急性肝衰竭患者预后的预测价值

DOI: 10.3969/j.issn.1001-5256.2022.11.008
基金项目: 

国家科技重大专项子课题 2018ZX10302205-004

伦理学声明:本研究方案于2022年9月7日经由郑州大学第一附属医院伦理委员会审批,批号:2022-KY-0999-001。所纳入患者均签署知情同意书。
利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
作者贡献声明:董少雨负责课题设计,资料分析,撰写论文;乔芳芳、刘笑负责收集数据和统计分析;张建营负责指导数据统计分析;孙长宇负责拟定写作思路,指导撰写文章并最后定稿。
详细信息
    通信作者:

    孙长宇,changyu8188@163.com

Value of age and D-dimer combined with Model for End-Stage Liver Disease in predicting the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure

Research funding: 

Sub-project of the National Science and Technology Major Project 2018ZX10302205-004

More Information
  • 摘要:   目的  探讨年龄和D-二聚体(D-D)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2019年12月—2021年10月在郑州大学第一附属医院住院治疗的111例HBV-ACLF患者,根据确诊后90 d预后分为生存组(n=49)和死亡组(n=62)。收集患者的临床资料,包括年龄、性别、基础肝病、ALT、AST、TBil、Alb、D-D、PT、纤维蛋白原(FIB)、PTA、INR、SCr、血清钠(Na),并计算MELD评分。采用免疫比浊法测定血浆D-D水平。计量资料两组间比较采用t检验或Mann-Whitney U检验;计数资料两组间比较采用χ2检验。采用二元Logistic回归分析影响患者预后的独立危险因素,受试者工作特征曲线(ROC曲线)用于评估预测变量的准确性。ROC曲线下面积(AUC)的比较采用Delong法。  结果  两组间年龄、TBil、D-D、PT、PTA、INR、SCr、Na、MELD评分比较差异均有统计学意义(P值均<0.05)。进一步二元Logistic回归分析发现,年龄(OR=1.088,95%CI:1.001~1.183,P=0.047)、D-D(OR=1.521,95%CI:1.078~2.145,P=0.017)和MELD评分(OR=1.892,95%CI:1.408~2.543,P<0.001)是影响HBV-ACLF患者预后的独立危险因素。年龄、MELD评分、D-D对HBV-ACLF预后预测的AUC分别为0.664、0.869、0.887,D-D联合年龄、年龄联合MELD评分、D-D联合MELD评分及三者联合的AUC分别为0.895、0.906、0.965、0.970,除D-D联合MELD评分外,三者联合的AUC较其他指标明显升高,差异均有统计学意义(P值均<0.05);三者联合的敏感度和特异度较高,分别是0.935、0.918。  结论  年龄、D-D、MELD评分是影响HBV-ACLF预后的独立危险因素,其中D-D和MELD评分对预后具有良好的预测价值,三者联合预测价值更高。

     

  • 图  1  年龄、D-D及MELD评分对HBV - ACLF预后预测的ROC曲线

    Figure  1.  ROC curve of D-D, age and MELD score in predicting the prognosis of HBV-ACLF

    表  1  HBV-ACLF患者入院情况

    Table  1.   Admission status of HBV-ACLF patients

    指标 生存组(n=49) 死亡组(n=62) 统计值 P
    年龄(岁) 43.33±9.69 48.78±12.28 t=2.549 0.012
    男/女(例) 38/11 46/16 χ2=0.168 0.682
    慢性乙型肝炎/肝硬化(例) 12/37 13/49 χ2=0.195 0.659
    ALT(U/L) 252.0(72.0~652.0) 186.0(46.0~593.5) Z=-0.502 0.616
    AST(U/L) 185.0(91.5~469.5) 172.5(73.5~422.5) Z=-0.499 0.618
    Alb(g/L) 30.8(28.3~38.2) 29.3(27.3~32.1) Z=-1.375 0.169
    TBil(μmol/L) 247.68±100.53 330.01±118.67 t=3.879 <0.001
    D-D(mg/L) 0.42(0.31~1.34) 1.89(1.50~3.59) Z=-6.987 <0.001
    PT(s) 24.40(22.05~27.70) 27.50(24.05~31.95) Z=-3.059 0.002
    FIB(g/L) 1.11(0.95~1.44) 1.16(0.90~1.39) Z=-0.358 0.720
    PTA(%) 32.0(27.0~36.0) 29.0(23.5~33.8) Z=-2.585 0.010
    INR 2.20(2.00~2.54) 2.44(2.16~2.95) Z=-3.035 0.002
    SCr(μmol/L) 51.8(42.0~67.5) 60.0(50.0~80.0) Z=-3.849 <0.001
    Na(mmol/L) 138(135~139) 135(131~139) Z=-3.017 0.003
    MELD评分 13.82(11.89~16.87) 17.46(14.84~21.35) Z=-6.663 <0.001
    下载: 导出CSV

    表  2  预后危险因素的单因素Logistic回归分析

    Table  2.   Univariate Logistic regression analysis of prognostic risk factors

    因素 β Wald值 OR 95%CI P
    性别 -0.184 0.167 0.832 0.345~2.006 0.682
    年龄 0.044 5.925 1.045 1.009~1.083 0.015
    慢性乙型肝炎/肝硬化 0.201 0.194 1.222 0.500~2.986 0.695
    D-D 2.093 22.715 8.113 3.430~19.189 <0.001
    FIB 0.132 0.264 1.142 0.689~1.890 0.607
    PT 0.980 6.587 1.103 1.023~1.189 0.010
    PTA -0.076 6.774 0.927 0.876~0.981 0.009
    INR 1.117 6.807 3.055 1.320~7.068 0.009
    ALT 0.000 0.009 1.000 0.999~1.001 0.924
    AST 0.000 0.134 1.000 0.999~1.001 0.714
    Alb -0.021 0.264 0.979 0.904~1.061 0.607
    TBil 0.007 12.109 1.007 1.003~1.011 0.001
    SCr 0.010 0.989 1.010 0.991~1.029 0.320
    Na -0.125 7.410 0.882 0.806~0.966 0.006
    MELD评分 0.489 25.266 1.646 1.355~1.999 <0.001
    下载: 导出CSV

    表  3  年龄、D-D及MELD评分对HBV-ACLF预后的预测价值

    Table  3.   The prognostic value of age, D-D and MELD score for HBV-ACLF

    指标 AUC 约登指数 临界值 敏感度(%) 特异度(%) P 95%CI
    年龄 0.664 0.209 44.5 59.7 61.2 0.003 0.563~0.764
    MELD评分 0.869 0.611 16.792 77.4 83.7 <0.001 0.802~0.937
    D-D 0.887 0.618 1.215 90.3 71.4 <0.001 0.826~0.948
    D-D联合年龄 0.895 0.685 0.506 83.9 81.6 <0.001 0.836~0.953
    年龄联合MELD评分 0.906 0.671 0.485 85.5 81.6 <0.001 0.851~0.961
    D-D联合MELD评分 0.965 0.813 0.427 93.5 87.8 <0.001 0.933~0.997
    D-D、年龄联合MELD评分 0.970 0.854 0.494 93.5 91.8 <0.001 0.941~0.999
    下载: 导出CSV
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