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血清游离三甲碘状腺原氨酸水平预测HBV相关慢加急性肝衰竭患者预后的价值分析

张剑 陈煜 段钟平

引用本文:
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血清游离三甲碘状腺原氨酸水平预测HBV相关慢加急性肝衰竭患者预后的价值分析

DOI: 10.3969/j.issn.1001-5256.2022.01.012
基金项目: 

国家科技重大专项“艾滋病和病毒性肝炎等重大传染病防治” (2017ZX10302201-004-002)

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:张剑负责课题设计,收集数据,资料分析,撰写论文;陈煜参与修改论文;段钟平负责拟定写作思路,指导撰写文章并最后定稿。
详细信息
    通信作者:

    段钟平,duan2517@163.com

Value of serum free triiodothyronine level in predicting the prognosis of patients with HBV-related acute-on-chronic liver failure

Research funding: 

National Science and Technology Key Project on "Major Infectious Disease such as HIV/AIDS, Viral Hepatitis Prevention and Treatment" (2017ZX10302201-004-002)

  • 摘要:   目的  探讨血清游离三甲碘状腺原氨酸(FT3)水平对HBV相关慢加急性肝衰竭(HBV-ACLF)患者90 d预后的预测价值。  方法  收集2018年9月—2020年1月在首都医科大学附属北京佑安医院住院的122例HBV-ACLF患者的临床资料,根据确诊后90 d预后分为生存组(n=77)和死亡组(n=45)。采用ELISA法测定血清FT3水平,比较FT3水平在两组间差异,应用logistic回归分析探索影响预后的危险因素并建立FT3相关预测模型,采用预测概率值的ROC曲线下面积(AUC)评估预测模型的区分度,采用线性回归分析评估校准度。采用AUC比较模型与MELD评分预测预后价值的差异。符合正态分布的计量资料两组间比较采用t检验;非正态分布的计量资料两组间比较采用Mann-Whitney U检验;计数资料两组间比较采用χ2检验;采用logistic回归分析预后影响因素。  结果  死亡组FT3显著低于生存组[(2.27±0.38) pmol/L vs (2.69±0.55) pmol/L,t=4.526, P<0.001], FT3(OR=0.534,95%CI:0.300~0.950,P=0.013)是影响预后的独立保护因素;年龄(OR=1.047,95%CI:1.013~1.082,P=0.007)、TBil(OR=1.096,95%CI:1.059~1.134,P<0.001)、INR(OR=1.101,95%CI:1.029~1.178,P<0.005)、Cr(OR=4.583,95%CI:2.102~7.992,P<0.001)是独立危险因素。FT3相关预测模型区分度的AUC为0.869(95%CI:0.831~0.907),P<0.001;校准能力R2=0.340,P=0.268。FT3相关公式预测预后的价值显著好于MELD评分(P<0.05)。  结论  FT3是HBV-ACLF患者90 d预后的独立影响因素,其与年龄、TBil、INR、Cr联合建立的FT3相关预测模型对患者90 d预后评估具有较好的预测价值。

     

  • 图  1  FT3相关公式得分预测累积概率与实测累积概率

    图  2  HBV-ACLF患者90 d预后的ROC曲线

    表  1  HBV-ACLF患者入院情况

    指标 生存组(n=77) 死亡组(n=45) 统计值 P
    年龄(岁) 44.65±10.58 48.85±10.13 t=4.551 <0.001
    男/女(例) 65/12 35/10 χ2=1.301 0.254
    慢性乙型肝炎/肝硬化(例) 31/46 14/31 χ2=7.345 0.007
    ALT(U/L) 285.81(112.27~521.15) 153.65(92.17~3 756.18) U=1.179 0.230
    AST(U/L) 153.50(92.95~434.76) 136.9(86.1~305.95) U=1.016 0.618
    TBil(mg/dL) 19.26±8.59 28.31±8.97 t=9.375 <0.001
    INR 2.73±1.27 5.23±1.86 t=4.859 <0.001
    Cr(mg/dL) 0.72±0.25 1.54±0.56 t=7.914 <0.001
    Alb(g/L) 32.34±3.95 31.72±4.19 t=-1.295 0.196
    Na(mmol/L) 136.22±3.67 133.65±6.91 t=-4.514 <0.001
    WBC(×109/L) 7.40(5.01~9.57) 9.19(6.04~10.56) U=8.573 0.001
    MELD 26.48±5.19 33.68±4.87 t=11.950 <0.001
    下载: 导出CSV

    表  2  预后危险因素的单因素logistic回归分析

    因素 β Wald值 OR 95%CI P
    年龄 0.054 18.305 1.055 1.030~1.082 <0.001
    性别 0.500 1.279 1.148 0.693~2.917 0.258
    慢性乙型肝炎/肝硬化 -0.689 7.213 0.502 0.303~0.830 0.007
    TBil 0.114 56.431 1.121 1.088~1.165 <0.001
    INR 0.193 5.594 1.213 1.034~1.423 0.018
    Alb -0.038 1.669 0.962 0.908~1.020 0.196
    Cr 2.226 28.933 9.259 4.115~14.834 <0.001
    Na -0.108 17.818 0.898 0.854~0.944 <0.001
    FT3 -0.982 18.478 0.375 0.240~0.586 <0.001
    WBC 0.070 9.919 1.073 1.027~1.120 0.002
    下载: 导出CSV

    表  3  预后危险因素的多因素logistic回归分析

    因素 β Wald值 OR 95%CI P
    年龄 0.046 7.330 1.047 1.013~1.082 0.007
    慢性乙型肝炎/肝硬化 -0.595 2.922 0.552 0.279~1.091 0.097
    TBil 0.092 27.979 1.096 1.059~1.134 <0.001
    INR 0.096 7.797 1.101 1.029~1.178 0.005
    Cr 1.522 14.649 4.583 2.102~7.992 <0.001
    Na -0.043 1.991 0.958 0.902~1.017 0.158
    FT3 -0.627 4.559 0.534 0.300~0.950 0.013
    WBC 0.011 0.159 1.011 0.956~1.070 0.690
    下载: 导出CSV
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