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外周血淋巴细胞计数在慢加急性肝衰竭短期预后评估中的价值

刘小花 杨淑娟 刘瑜珊 李娟 张巧 王亚敏 闫涛涛 杨瑗 赵英仁 何英利

引用本文:
Citation:

外周血淋巴细胞计数在慢加急性肝衰竭短期预后评估中的价值

DOI: 10.3969/j.issn.1001-5256.2023.10.016
基金项目: 

国家自然科学基金 (81971310);

陕西省感染性疾病临床医学研究中心项目 (2020LCZX-01);

西安交通大学第一附属医院感染病临床研究中心项目 (XJTU1AF2021CRF-006);

西安交通大学第一附属医院感染病临床研究中心项目 (2022-XKCRC-04);

陕西省重点研发项目 (2018ZDXM-SF-037)

伦理学声明:本研究方案于2023年1月17日经由西安交通大学第一附属医院伦理委员会审批,批号:XJTU1AF2023LSK-019,并在clinical trial注册(注册号:NCT05740696),患者均签署知情同意书。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:刘小花、杨淑娟、刘瑜珊、李娟、张巧、王亚敏参与了研究数据的获取分析解释过程;李娟、闫涛涛、杨瑗、赵英仁、何英利对研究的思路或设计有关键贡献;刘小花、杨淑娟、刘瑜珊参与起草或修改文章关键内容。
详细信息
    通信作者:

    何英利, heyingli2000@xjtu.edu.cn (ORCID: 0000-0001-9444-3678)

Value of peripheral blood lymphocyte count in evaluating the short-term prognosis of patients with acute-on-chronic liver failure

Research funding: 

National Natural Science Foundation of China (81971310);

Project of Shaanxi Provincial Clinical Medical Research Center for Infectious Diseases (2020LCZX-01);

Clinical Research Center for Infectious Diseases, the First Affiliated Hospital of Xi’an Jiaotong University (XJTU1AF2021CRF-006);

Clinical Research Center for Infectious Diseases, the First Affiliated Hospital of Xi’an Jiaotong University (2022-XKCRC-04);

Key Research and Development Project of Shaanxi Province (2018ZDXM-SF-037)

More Information
  • 摘要:   目的  探讨慢加急性肝衰竭(ACLF)患者预后影响因素,建立短期预后模型。  方法  回顾2011年1月—2016年12月在西安交通大学第一附属医院感染科住院的247例ACLF患者的基线临床资料。将患者分为生存组及死亡组,比较组间差异,分析预后影响因素,同时建立预后模型,应用受试者工作特征曲线(ROC曲线)评估预测效能并确定最佳截断值。正态分布的计量资料两组间比较采用成组t检验;不服从正态分布的资料两组间比较采用Mann-Whitney U秩和检验;计数资料两组间比较采用Fisher精确检验或Pearson卡方检验。Logistic单因素及多因素分析28天、90天预后相关的独立危险因素。使用Kaplan-Meier方法绘制28天生存曲线。  结果  经纳入及排除标准筛选后共纳入ACLF患者220例,28天生存组148例、死亡组72例,28天无移植生存率67.27%;90天生存组115例、死亡组105例,90天无移植生存率52.27%。Logistic回归分析结果显示女性(OR=2.149,P=0.030)、高MELD评分(OR=1.120,P<0.001)、外周血低淋巴细胞计数(OR=0.411,P=0.002)是影响28天预后的独立危险因素;据此建立影响28天预后的LS-MELD模型:-3.432+0.765×性别-0.890×淋巴细胞计数×10-9+0.113×MELD(性别赋值:男性为1,女性为2)。经ROC曲线确定模型的最佳截断值为0.35,据此将患者分为低LS-MELD组(≤0.35)及高LS-MELD组(>0.35),低LS-MELD组的28天生存率显著高于高LS-MELD组(P<0.001)。  结论  外周血淋巴细胞计数及性别联合MELD评分对ALCF患者的短期预后具有预测价值。

     

  • 图  1  LS-MELD模型与MELD评分预测生存结局的ROC曲线

    Figure  1.  ROC curve of LS-MELD model and MELD score for predicting survival outcome

    图  2  28天生存曲线

    Figure  2.  28-day survival curve

    表  1  220例ACLF患者基线一般资料及实验室指标

    Table  1.   Baseline general data and laboratory indicators of 220 patients with ACLF

    指标 数值
    年龄(岁) 45.00(37.00~56.75)
    性别(男/女,例) 163/57
    腹水(有/无,例) 127/93
    肝性脑病(有/无,例) 84/136
    消化道出血(有/无,例) 12/208
    肝肾综合征(有/无,例) 27/193
    感染(有/无,例) 151/69
    高血压(有/无,例) 11/209
    糖尿病(有/无,例) 14/206
    病因(HBV/HEV/酒精/药物/免疫/其他,例) 156/4/3/11/1/45
    ALT(U/L) 279.13(90.58~687.53)
    AST(U/L) 241.00(107.24~293.75)
    TBil(μmol/L) 304.95(202.30~410.45)
    Alb(g/L) 30.6±4.9
    Glo(g/L) 29.65(24.34~36.70)
    BUN(mmol/L) 4.19(2.92~6.20)
    肌酐(μmol/L) 62.0(50.1~78.7)
    INR 2.23(1.80~2.95)
    FIB(g/L) 1.21(0.96~1.68)
    Hb(g/L) 124(102~141)
    PLT(×109/L) 90.0(55.0~132.5)
    WBC(×109/L) 6.52(4.76~8.68)
    淋巴细胞计数(×109/L) 1.11(0.78~1.54)
    淋巴细胞百分比 15.52(8.78~24.28)
    中性粒细胞计数(×109/L) 5.30(3.46~8.24)
    中性粒细胞百分比 70.50(61.65~79.28)
    MELD评分 22.89(18.99~27.44)
    下载: 导出CSV

    表  2  28天、90天生存组及死亡组临床资料与实验室指标对比

    Table  2.   Comparison of clinical data and laboratory indexes between 28-day, 90-day survival group and death group

    指标 28天生存组 (n=148) 28天死亡组 (n=72) 统计值 P 90天生存组 (n=115) 90天死亡组 (n=105) 统计值 P
    年龄(岁) 45.0(35.0~45.0) 44.5(38.0~60.0) Z=-1.085 0.278 45.0(34.0~55.0) 46.0(39.5~60.0) Z=-1.961 0.050
    性别(男/女,例) 116/32 47/25 χ2=4.330 0.037 93/22 70/35 χ2=5.768 0.016
    腹水(有/无,例) 85/63 42/30 χ2=0.016 0.899 65/50 62/43 χ2=0.143 0.705
    肝性脑病(有/无,例) 39/109 45/27 χ2=26.815 <0.001 25/90 59/46 χ2=27.600 <0.001
    消化道出血(有/无,例) 5/143 7/65 χ2=2.650 0.104 3/112 9/96 χ2=3.784 0.052
    肝肾综合征(有/无,例) 14/134 13/59 χ2=3.324 0.068 5/110 22/83 χ2=14.055 <0.001
    感染(有/无,例) 94/54 57/15 χ2=5.513 0.019 75/40 76/29 χ2=1.308 0.253
    高血压(有/无,例) 5/143 6/66 χ2=1.569 0.210 3/112 8/97 χ2=2.901 0.089
    糖尿病(有/无,例) 7/141 7/65 χ2=1.275 0.259 6/109 8/97 χ2=0.531 0.466
    ALT(U/L) 281.69(99.91~648.05) 277.00(76.60~725.89) Z=-0.564 0.573 282.37(134.00~700.11) 275.00(74.64~645.10) Z=-1.071 0.284
    AST(U/L) 244.50(109.58~525.15) 214.45(93.33~701.00) Z=-0.131 0.896 260.00(115.00~534.80) 202.00(94.51~630.50) Z=-0.868 0.385
    TBil(μmol/L) 284.70(199.10~368.78) 366.83(208.28~426.21) Z=-2.067 0.039 262.40(193.00~341.14) 367.50(225.04~431.30) Z=-3.856 <0.001
    Alb(g/L) 30.50±0.42 30.47±0.58 t=0.036 0.971 30.51±5.22 30.38±4.68 t=0.323 0.747
    Glo(g/L) 30.30(24.68~37.18) 29.30(23.20~34.23) Z=-1.367 0.172 31.10(25.80~37.64) 28.60(23.05~34.16) Z=-2.292 0.022
    BUN(mmol/L) 4.11(3.04~5.54) 4.60(2.83~8.10) Z=-1.346 0.178 3.98(2.86~5.14) 4.46(2.98~7.94) Z=-2.214 0.027
    肌酐(μmol/L) 61.60(50.16~76.00) 62.00(49.35~86.85) Z=-0.516 0.606 61.30(50.64~76.29) 62.00(48.60~81.60) Z=-0.288 0.773
    INR 2.01(1.71~2.63) 2.85(2.23~4.21) Z=-5.504 <0.001 1.97(1.71~2.42) 2.67(1.95~3.89) Z=-4.716 <0.001
    FIB(g/L) 1.32(0.99~1.73) 1.11(0.84~1.48) Z=-2.779 0.005 1.29(1.00~1.68) 1.16(0.90~1.68) Z=-1.663 0.096
    Hb(g/L) 126.00(109.00~141.75) 119.50(97.25~138.00) Z=-1.670 0.095 126.00±23.66 118.05±26.42 t=2.281 0.024
    PLT(×109/L) 90.50(59.25~133.50) 87.50(50.25~132.50) Z=-0.742 0.458 98.00(60.00~153.00) 80.00(51.00~125.00) Z=-1.795 0.073
    WBC(×109/L) 6.48(4.58~8.68) 6.68(5.07~8.68) Z=-0.445 0.657 6.21(4.49~8.35) 6.80(5.19~9.14) Z=-1.674 0.094
    淋巴细胞计数(×109/L) 1.18(0.89~1.59) 0.89(0.60~1.39) Z=-3.208 0.001 1.18(0.89~1.59) 1.00(0.65~1.47) Z=-2.559 0.011
    淋巴细胞百分比(%) 18.10(10.26~25.43) 11.20(6.59~20.90) Z=-2.982 0.003 18.34(9.63~27.50) 13.40(7.57~22.05) Z=-2.218 0.027
    中性粒细胞计数(×109/L) 4.99(3.32~7.63) 5.66(3.96~9.58) Z=-1.219 0.223 4.54(3.22~7.58) 5.59(3.92~8.87) Z=-1.124 0.261
    中性粒细胞百分比(%) 68.22(59.83~78.21) 73.47(66.33~81.69) Z=-2.806 0.005 67.00(58.10~77.00) 73.70(65.60~87.92) Z=-3.734 <0.001
    MELD评分 21.80(18.54~25.60) 26.20(22.16~32.91) Z=-4.422 <0.001 21.31(17.96~25.19) 24.96(21.30~31.65) Z=-4.410 <0.001
    下载: 导出CSV

    表  3  影响ACLF患者28天生存的单因素及多因素分析

    Table  3.   Univariate and multivariate analysis of 28-day prognosis in ACLF patients

    指标 单因素分析 多因素分析
    OR(95%CI P OR(95%CI P
    年龄(岁) 1.015(0.995~1.036) 0.137
    性别 1.928(1.034~3.596) 0.039 2.149(1.076~4.292) 0.030
    感染 3.080(0.942~10.069) 0.063
    肝肾综合征 2.109(0.934~4.763) 0.073
    Hb(g/L) 0.989(0.978~1.000) 0.059
    PLT(×109/L) 0.998(0.993~1.002) 0.340
    淋巴细胞计数(×109/L) 0.444(0.254~0.776) 0.004 0.411(0.231~0.730) 0.002
    中性粒细胞百分比(%) 1.035(1.010~1.060) 0.005
    FIB(g/L) 0.561(0.324~0.971) 0.039
    MELD评分 1.107(1.058~1.159) <0.001 1.120(1.066~1.176) <0.001
    下载: 导出CSV
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