血清胱抑素C联合总胆红素对慢加急性肝衰竭患者短期预后的预测价值

摘要

目的 探讨血清胱抑素C(CysC)联合总胆红素(TBil)对乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者短期预后的预测价值.方法 入选2012年1月至2016年1月在西京消化病医院住院且资料完整的HBV-ACLF患者,统计患者入院24 h内的一般资料、各项临床检测指标、Child-Turcotte-Pugh评分(CTP评分)、终末期肝病模型评分(MELD评分),所有患者均随访90 d,根据转归分为生存组和死亡组,Logistic多因素回归分析影响患者预后的独立危险因素.结果 162例患者中死亡78例,血清CysC、TBil是影响HBV-ACLF患者生存的独立危险因素.血清CysC与血肌酐(Cr)、MELD评分呈正相关,Spearman相关系数分别为0.400、0.416,均P<0.01.联合血清CysC与TBil组成的预后模型(PM)的ROC曲线下面积(AUC)为0.833,其早期预测HBV-ACLF患者90 d死亡与否的价值高于CTP评分、MELD评分(P<0.05).高危组(PM≥3.07)90 d生存率为23.8％,低危组(PM<3.07)为79.3％(P<0.01).结论 血清CysC联合TBil建立的预后模型是一个简单易用的评分模型,且对HBV-ACLF患者90 d病死率的预测作用优于CTP和MELD评分.%Objective To investigate the prognostic value of combined serum cystatin C (CysC) and total bilirubin (TBil) for patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).Methods In the retrospective analysis,162 patients with HBV-ACLF admitted in our hospital from January 2012 to January 2016 were enrolled.Baseline clinical information,laboratory examination results,Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease (MELD) score were collected within 24 h after admission.All patients were followed up for 90 days and divided into survival and death groups according to prognoses.Multivariate logistic regression analysis was applied to identify independent risk factors.