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肝衰竭是一组临床常见的严重症候群,可由多种因素造成,在中国慢加急性肝衰竭(acute on chronic liver failure,ACLF)是肝衰竭中最常见的类型,该病进展快,无特效治疗,晚期ACLF病人病死率可达76%[1-2],预后极差。尽早准确地评估病人病情,及时有效地调整治疗方案对改善预后极其重要,故本研究通过对95例不同预后ACLF病人的临床数据进行回顾性分析,评估各个指标在ACLF病人短期预后中的价值。
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本研究共纳入95例病人,其中男81例,女14例,平均(48.57±13.68)岁。随访30 d期间38例死亡(死亡组),57例生存(生存组)。2组病人年龄、性别方面差异均无统计学意义(P>0.05),2组病人在并发AKI和MELD评分方面差异均有统计学意义(P < 0.05)(见表 1)。
分组 n 年龄(x±s)/岁 男 女 并发AKI MELD评分[P50(P25~P75)] 死亡组 38 50.32±13.86 32 6 11 29.00(26.00~34.00) 生存组 57 47.40±13.55 49 8 6 23.00(20.50~26.00) χ2 — 1.02* 0.06 5.27 5.05# P — >0.05 >0.05 < 0.05 < 0.01 *示t值; #示Z值 表 1 2组病人一般资料的比较
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死亡组WBC、NEU、CysC、PT、INR水平均高于生存组,TG、ApoB、PTA水平均低于生存组(P < 0.05~P < 0.01),PLT、ALT、TBil、CHE、Alb、SCr、Na+、ApoA、D-Dimer在2组间差异均无统计学意义(P>0.05)(见表 2)。
指标 死亡组(n=38) 生存组(n=57) t P WBC/×109 9.29±1.34 7.37±3.91 2.24 < 0.05 NEU/×109 6.87±4.03 5.05±3.60 2.30 < 0.05 PLT/×109 106.39±53.99 119.51±42.67 1.32 >0.05 ALT[P50(P25~P75)]/(U/L) 312.50(106.00~734.50) 213.00(91.00~602.50) 0.56* >0.05 TBil[P50(P25~P75)](μmol/L) 328.60(240.45~382.75) 283.60(217.70~366.10) 1.01* >0.05 CHE[P50(P25~P75)]/(U/L) 2 616.00(1 990.00~3 873.00) 3 154.00(2 064.00~4 639.00) 1.33* >0.05 Alb/(g/L) 29.70±7.04 30.84±5.19 0.91 >0.05 SCr[P50(P25~P75)]/(umol/L) 61.50(53.75~96.75) 63(50.50~68.00) 1.28* >0.05 Na+/(mmol/L) 133.61±7.04 135.77±5.72 1.65 >0.05 TG/(mmol/L) 1.27±0.79 1.72±0.89 2.52 < 0.05 ApoA/(g/L) 0.23±0.18 0.27±0.18 1.04 >0.05 ApoB/(g/L) 0.61±0.40 0.82±0.36 2.63 < 0.05 D-Dimer[P50(P25~P75)]/(mg/L) 1.90(1.26~5.99) 2.08(0.85~2.82) 1.07* >0.05 PT[P50(P25~P75)]/s 30.40(24.05~37.93) 19.50(17.20~23.95) 4.84* < 0.01 INR[P50(P25~P75)] 2.57(2.03~3.21) 1.76(1.50~2.11) 4.70* < 0.01 PTA/% 27.90±17.50 43.16±14.35 4.65 < 0.01 CysC[P50(P25~P75)]/(mg/L) 1.52(1.20~2.14) 1.22(1.00~1.40) 3.44* < 0.01 *示Z值 表 2 实验室指标比较(x±s)
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以ACLF病人30 d随访结果是否死亡为因变量,将2组间单因素分析差异有统计学意义的WBC、NEU、TG、ApoB、CysC、PT、INR、PTA、并发AKI、MELD评分等指标作为自变量纳入多因素logistic回归方程,结果显示CysC是ACLF病人短期(30 d)死亡的独立危险因素(P < 0.05)(见表 3)。
指标 B SE Waldχ2 P OR 95%CI WBC/(×109) 0.365 0.320 1.30 >0.05 1.441 0.769~2.700 NEU/(×109) -0.260 0.331 0.62 >0.05 0.771 0.403~1.474 TG/(mmol/L) 0.021 0.562 0.00 >0.05 1.021 0.339~3.074 ApoB/(g/L) -0.098 1.106 0.01 >0.05 0.907 0.104~7.933 CysC/(mg/L) 2.020 0.895 5.09 < 0.05 7.536 1.304~43.535 PT/s 0.098 0.089 1.20 >0.05 1.102 0.926~1.313 INR 1.200 1.351 0.79 >0.05 3.319 0.235~46.887 PTA/% 0.030 0.041 0.56 >0.05 1.031 0.952~1.116 并发AKI 1.311 0.972 1.82 >0.05 3.712 0.552~24.940 MELD评分/分 -0.038 0.154 0.06 >0.05 0.963 0.712~1.303 常量 -10.999 4.792 5.27 < 0.05 0 — 表 3 多因素logistic分析结果
影响慢加急性肝衰竭短期预后的危险因素分析
Analysis of risk factors affecting short-term prognosis of acute on chronic liver failure
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摘要:
目的分析慢加急性肝衰竭(ACLF)病人的临床数据,探究影响其短期预后的危险因素。 方法收集95例ACLF病人的相关资料,根据入院确诊后30 d预后情况分为死亡组(38例)和生存组(57例),分析影响ACLF病人短期预后的相关危险因素。 结果2组病人入院时白细胞计数、中性粒细胞计数、三酰甘油、载脂蛋白B、凝血酶原时间、国际标准化比值、凝血酶原活动度、胱抑素C(CysC)、并发急性肾损伤(AKI)、终末期肝病模型(MELD)评分差异均有统计学意义(P < 0.05~P < 0.01);多因素logistic分析提示CysC是影响ACLF病人短期预后的危险因素。 结论CysC较血肌酐更早预警ACLF病人并发AKI可能,且其是影响ACLF病人短期预后的独立危险因素。 Abstract:ObjectiveTo analyze the clinical data of patients with acute on chronic liver failure (ACLF) and determine the risk factors affecting the short-term prognosis. MethodsThe relevant data of 95 patients with ACLF were collected and divided into the death group (38 cases) and survival group (57 cases) according to the prognosis 30 days after admission.Then the relevant risk factors affecting the short-term prognosis of ACLF patients were analyzed. ResultsThere were significant differences in white blood cell count, neutrophil count, triglyceride, apolipoprotein B, prothrombin time, international normalized ratio, prothrombin activity, cystatin C (CysC), complication with acute kidney injury and the score of model for end-stage liver disease (MELD) between the two groups at admission (P < 0.05 to P < 0.01).Multivariate logistic analysis suggested that CysC was a risk factor for short-term prognosis of patients with ACLF. ConclusionsCysC is an earlier warning factor for ACLF patients complicated with AKI than Cr, which is an independent risk factor for the short-term prognosis of ACLF patients. -
Key words:
- acute-on-chronic liver failure /
- cystatin C /
- prognosis /
- risk factors
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表 1 2组病人一般资料的比较
分组 n 年龄(x±s)/岁 男 女 并发AKI MELD评分[P50(P25~P75)] 死亡组 38 50.32±13.86 32 6 11 29.00(26.00~34.00) 生存组 57 47.40±13.55 49 8 6 23.00(20.50~26.00) χ2 — 1.02* 0.06 5.27 5.05# P — >0.05 >0.05 < 0.05 < 0.01 *示t值; #示Z值 表 2 实验室指标比较(x±s)
指标 死亡组(n=38) 生存组(n=57) t P WBC/×109 9.29±1.34 7.37±3.91 2.24 < 0.05 NEU/×109 6.87±4.03 5.05±3.60 2.30 < 0.05 PLT/×109 106.39±53.99 119.51±42.67 1.32 >0.05 ALT[P50(P25~P75)]/(U/L) 312.50(106.00~734.50) 213.00(91.00~602.50) 0.56* >0.05 TBil[P50(P25~P75)](μmol/L) 328.60(240.45~382.75) 283.60(217.70~366.10) 1.01* >0.05 CHE[P50(P25~P75)]/(U/L) 2 616.00(1 990.00~3 873.00) 3 154.00(2 064.00~4 639.00) 1.33* >0.05 Alb/(g/L) 29.70±7.04 30.84±5.19 0.91 >0.05 SCr[P50(P25~P75)]/(umol/L) 61.50(53.75~96.75) 63(50.50~68.00) 1.28* >0.05 Na+/(mmol/L) 133.61±7.04 135.77±5.72 1.65 >0.05 TG/(mmol/L) 1.27±0.79 1.72±0.89 2.52 < 0.05 ApoA/(g/L) 0.23±0.18 0.27±0.18 1.04 >0.05 ApoB/(g/L) 0.61±0.40 0.82±0.36 2.63 < 0.05 D-Dimer[P50(P25~P75)]/(mg/L) 1.90(1.26~5.99) 2.08(0.85~2.82) 1.07* >0.05 PT[P50(P25~P75)]/s 30.40(24.05~37.93) 19.50(17.20~23.95) 4.84* < 0.01 INR[P50(P25~P75)] 2.57(2.03~3.21) 1.76(1.50~2.11) 4.70* < 0.01 PTA/% 27.90±17.50 43.16±14.35 4.65 < 0.01 CysC[P50(P25~P75)]/(mg/L) 1.52(1.20~2.14) 1.22(1.00~1.40) 3.44* < 0.01 *示Z值 表 3 多因素logistic分析结果
指标 B SE Waldχ2 P OR 95%CI WBC/(×109) 0.365 0.320 1.30 >0.05 1.441 0.769~2.700 NEU/(×109) -0.260 0.331 0.62 >0.05 0.771 0.403~1.474 TG/(mmol/L) 0.021 0.562 0.00 >0.05 1.021 0.339~3.074 ApoB/(g/L) -0.098 1.106 0.01 >0.05 0.907 0.104~7.933 CysC/(mg/L) 2.020 0.895 5.09 < 0.05 7.536 1.304~43.535 PT/s 0.098 0.089 1.20 >0.05 1.102 0.926~1.313 INR 1.200 1.351 0.79 >0.05 3.319 0.235~46.887 PTA/% 0.030 0.041 0.56 >0.05 1.031 0.952~1.116 并发AKI 1.311 0.972 1.82 >0.05 3.712 0.552~24.940 MELD评分/分 -0.038 0.154 0.06 >0.05 0.963 0.712~1.303 常量 -10.999 4.792 5.27 < 0.05 0 — -
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