肝功能衰竭患者主要临床指标与预后的关系
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摘要
目的分析肝功能衰竭患者主要临床指标与预后的关系。方法选取2008年1月至2014年12月首都医科大学附属北京地坛医院收治的96例肝功能衰竭患者为研究对象,住院期间或出院90 d内病死者为病死组(36例),其余为存活组(60例),分析两组患者肝功能、肾功能、电解质、血糖(blood glucose,Glu)、甘油三酯(triglyceride,TG)、胆固醇(total cholesterol,TC)、甲胎蛋白(alpha feto protein,AFP)、凝血酶原活动度(prothrombin activity,PTA)等指标的差异,采用多因素Logistic回归模型分析肝功能衰竭预后的独立危险因素。结果病死组与存活组患者总胆红素(total bilirubin,TBil)、白蛋白(albumin,ALB)、AFP、PTA、血钠(serum sodium,Na)、白细胞(leukocyte,WBC)、血肌酐(serumcreatinine,SCr)及Glu水平差异有统计学意义(P均<0.05)。多因素Logistic回归分析表明PTA和SCr是肝衰竭预后的独立影响因素(OR=0.919,P=0.006;OR=5.594,P<0.001)。ROC曲线分析表明PTA和SCr的曲线下面积(areaundercurve,AUC)分别为0.732、0.828,相应Cut-off值分别为21%(敏感度64%,特异性72%)和128μmol/L(敏感度69%,特异性88%)。结论 PTA和SCr为肝功能衰竭患者预后的独立影响因素,PTA为保护因素,SCr为危险因素。
Objective To analyze the relationship between main clinical indexes and prognosis of patients with liver failure. Methods Total of 96 cases with liver failure in Beijing Ditan Hospital, Capital Medical University from January 2008 to December 2014 were selected, patients died in the hospital or discharged from hospital within 90 days were in death group(36 cases), and the rest were in surviving group(60 cases). The differences of liver function, renal function, electrolyte, blood glucose(Glu), triglyceride(TG), total cholesterol(TC), alpha feto protein(AFP) and prothrombin activity(PTA) of patients in two groups were compared. The independent risk factors for prognosis of liver failure were analyzed by multivariate Logistic regression analysis. There were significant differences in total bilirubin(TBil), albumin(ALB), AFP, PTA, serum sodium(Na), leukocyte(WBC), serum creatinine(SCr) and Glu levels between the two groups(P < 0.05). Results Logistic regression analysis showed that PTA(OR = 0.919, P = 0.006) and SCr(OR = 5.594, P < 0.001) were independent risk factors for the prognosis of liver failure. ROC curve showed that the area under curve(AUC) of PTA and SCr were 0.732 and 0.828, respectively. The corresponding Cut-off values were 21%(sensitivity 64%, specificity 72%) and 128 μmol/L(sensitivity 69%, specificity 88%), respectively. Conclusions PTA and SCr were independent prognostic factors that affect the prognosis of patients with liver failure. PTA was the protective factor and SCr was the risk factor.
Objective To analyze the relationship between main clinical indexes and prognosis of patients with liver failure. Methods Total of 96 cases with liver failure in Beijing Ditan Hospital, Capital Medical University from January 2008 to December 2014 were selected, patients died in the hospital or discharged from hospital within 90 days were in death group(36 cases), and the rest were in surviving group(60 cases). The differences of liver function, renal function, electrolyte, blood glucose(Glu), triglyceride(TG), total cholesterol(TC), alpha feto protein(AFP) and prothrombin activity(PTA) of patients in two groups were compared. The independent risk factors for prognosis of liver failure were analyzed by multivariate Logistic regression analysis. There were significant differences in total bilirubin(TBil), albumin(ALB), AFP, PTA, serum sodium(Na), leukocyte(WBC), serum creatinine(SCr) and Glu levels between the two groups(P < 0.05). Results Logistic regression analysis showed that PTA(OR = 0.919, P = 0.006) and SCr(OR = 5.594, P < 0.001) were independent risk factors for the prognosis of liver failure. ROC curve showed that the area under curve(AUC) of PTA and SCr were 0.732 and 0.828, respectively. The corresponding Cut-off values were 21%(sensitivity 64%, specificity 72%) and 128 μmol/L(sensitivity 69%, specificity 88%), respectively. Conclusions PTA and SCr were independent prognostic factors that affect the prognosis of patients with liver failure. PTA was the protective factor and SCr was the risk factor.
引文
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[18]李蓥,詹婧,王中峰.HBV相关慢加急性肝衰竭患者预后危险因素分析[J].临床肝胆病杂志,2017,33(3):497-501.
[19]宁更献,李力,侯军良,等.慢加急性肝衰竭病因、临床特点与预后关系分析[J].河北医药,2017,39(2):214-216.
[20]刘平,龚作炯,孟忠吉.乙型肝炎肝衰竭的临床特征及治疗分析[J].中西医结合肝病杂志,2015,25(2):69-73.
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[23]高梦丹,侯玉丽,覃岭,等.慢加急性肝衰竭患者生存情况影响因素分析[J].北京医学,2018,40(4):293-296.
[24]谢能文,何金秋.肝衰竭的预后评估模型研究进展[J].江西医药,2014,49(11):1333-1337.
[25]王成成,黄芬.慢加急性(亚急性)肝衰竭及慢性肝衰竭预后危险因素分析[J].临床内科杂志,2015,32(2):112-115.
[26]吴家箴,杨兴祥,江南.乙肝慢加急性肝衰竭患者血清白蛋白水平和MELD评分关系分析[J].航空航天医学杂志,2017,28(7):811-812.
[27]高飞,张卫青,梁首勤,等.血清白蛋白、前白蛋白和转铁蛋白在评价慢性肝衰竭患者营养支持中的应用[J].实用医学杂志,2017,33(4):603-605.
[28]赵翠萍,张小丽,王艳红.慢加急性肝衰竭96例临床分析[J].中国实用医刊,2012,39(24):58-59.
[2]Li H,Xia Q,Zeng B,et al.Submassive hepatic necrosis distinguishes HBV-associated acute on chronic liver failure from cirrhotic patients with acute decompensation[J].J Hepatol,2015,63(1):50-59.
[3]中华医学会感染病学分会,肝衰竭与人工肝学组.中华医学会肝病学分会重型肝病与人工肝学组.肝竭诊治指南(2012年版)[J].中华肝脏病杂志,2013,21(3):177-183.
[4]占国清,谭华炳,李芳,等.甲胎蛋白、血浆凝血酶原活动度与血清前白蛋白联合检测对慢加急性肝衰竭预后的价值[J].临床消化病杂志,2014,26(4):218-220.
[5]刘华,詹东昂,罗红霞,等.甲胎蛋白对重型乙型肝炎患者生存状况的预测效果[J].国际病毒学杂志,2016,23(3):181-183.
[6]杨昊臻,朱冰,游绍莉,等.127例戊型肝炎肝衰竭的临床特点和预后分析[J].中华肝脏病杂志,2017,25(5):380-382.
[7]周宪伟,房忠卫.血浆凝血酶原活动度和血清甲胎蛋白、前白蛋白联合检测在人工肝血浆置换治疗重型肝炎的临床意义[J].中国医师进修杂志,2017,40(9):773-776.
[8]卢振,王瑜芬.凝血指标和血小板参数在肝病进展中的变化规律[J].国际检验医学杂志,2017,38(7):921-923.
[9]赵萍,翟玉峰,张怀宏.血清甲胎蛋白和凝血酶原活动度水平对慢加急性肝衰竭患者预后的预测价值研究[J].实用肝脏病杂志,2017,20(2):230-231.
[10]姜春华,傅小凡.乙型肝炎肝衰竭患者预后影响因素Logistic回归分析[J].国际医药卫生导报,2017,23(5):653-656.
[11]杨启,胡蓉,曾义岚,等.慢性乙型重症肝炎预后的影响因素[J/CD].中国肝脏病杂志(电子版),2015,7(4):94-96.
[12]杨志林,马坤,贾天贵,等.影响重型肝炎生存因素的分析[J].肝脏,2013,18(8):552-554.
[13]李晨,吕飒,朱冰,等.乙型肝炎病毒相关慢加急性肝衰竭患者近期预后危险因素的研究[J].中华肝脏病杂志,2016,24(3):207-213.
[14]赵紫烟,安雪青,史丽,等.血清前白蛋白/总胆红素比值对肝衰竭患者预后的预测价值[J].中国现代医学杂志,2017,27(21):75-78.
[15]杨志林,马坤,贾天贵,等.影响重型肝炎生存因素的分析[J].肝脏,2013,18(8):552-554.
[16]吴刚,陈娟.重型肝炎合并自发性细菌性腹膜炎的临床特点和诊疗效果观察[J].中国医药导报,2013,10(35):8-10.
[17]吴晓庆,万红.肝衰竭预后的危险因素分析[J].临床肝胆病杂志,2013,29(4):294-296.
[18]李蓥,詹婧,王中峰.HBV相关慢加急性肝衰竭患者预后危险因素分析[J].临床肝胆病杂志,2017,33(3):497-501.
[19]宁更献,李力,侯军良,等.慢加急性肝衰竭病因、临床特点与预后关系分析[J].河北医药,2017,39(2):214-216.
[20]刘平,龚作炯,孟忠吉.乙型肝炎肝衰竭的临床特征及治疗分析[J].中西医结合肝病杂志,2015,25(2):69-73.
[21]张静,周新民.肝衰竭的病情评估及预后判断[J].临床肝胆病杂志,2016,32(9):1673-1677.
[22]曹欣,关玉娟,李剑萍.慢性乙型重型肝炎预后因素分析[J].国际医药卫生导报,2013,19(23):3578-3581.
[23]高梦丹,侯玉丽,覃岭,等.慢加急性肝衰竭患者生存情况影响因素分析[J].北京医学,2018,40(4):293-296.
[24]谢能文,何金秋.肝衰竭的预后评估模型研究进展[J].江西医药,2014,49(11):1333-1337.
[25]王成成,黄芬.慢加急性(亚急性)肝衰竭及慢性肝衰竭预后危险因素分析[J].临床内科杂志,2015,32(2):112-115.
[26]吴家箴,杨兴祥,江南.乙肝慢加急性肝衰竭患者血清白蛋白水平和MELD评分关系分析[J].航空航天医学杂志,2017,28(7):811-812.
[27]高飞,张卫青,梁首勤,等.血清白蛋白、前白蛋白和转铁蛋白在评价慢性肝衰竭患者营养支持中的应用[J].实用医学杂志,2017,33(4):603-605.
[28]赵翠萍,张小丽,王艳红.慢加急性肝衰竭96例临床分析[J].中国实用医刊,2012,39(24):58-59.