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高密度脂蛋白胆固醇对HBV相关慢加急性肝衰竭严重程度及预后的预测价值

徐英 黄小平 陈丽 孙蔚 李文婷 王艳 甘建和

徐英, 黄小平, 陈丽, 等. 高密度脂蛋白胆固醇对HBV相关慢加急性肝衰竭严重程度及预后的预测价值[J]. 临床肝胆病杂志, 2021, 37(7): 1632-1635. DOI: 10.3969/j.issn.1001-5256.2021.07.030
引用本文: 徐英, 黄小平, 陈丽, 等. 高密度脂蛋白胆固醇对HBV相关慢加急性肝衰竭严重程度及预后的预测价值[J]. 临床肝胆病杂志, 2021, 37(7): 1632-1635. DOI: 10.3969/j.issn.1001-5256.2021.07.030
XU Y, HUANG XP, CHEN L, et al. Value of high-density lipoprotein cholesterol in evaluating the severity and prognosis of hepatitis B virus-associated acute-on-chronic liver failure[J]. J Clin Hepatol, 2021, 37(7): 1632-1635. DOI: 10.3969/j.issn.1001-5256.2021.07.030
Citation: XU Y, HUANG XP, CHEN L, et al. Value of high-density lipoprotein cholesterol in evaluating the severity and prognosis of hepatitis B virus-associated acute-on-chronic liver failure[J]. J Clin Hepatol, 2021, 37(7): 1632-1635. DOI: 10.3969/j.issn.1001-5256.2021.07.030

高密度脂蛋白胆固醇对HBV相关慢加急性肝衰竭严重程度及预后的预测价值

DOI: 10.3969/j.issn.1001-5256.2021.07.030
基金项目: 

国家科技部“十三五”重大专项 2017ZX10203201002-002

详细信息
    通讯作者:

    甘建和,ganjianhe@aliyun.com

  • 中图分类号: R575.3;R512.62

Value of high-density lipoprotein cholesterol in evaluating the severity and prognosis of hepatitis B virus-associated acute-on-chronic liver failure

Funds: 

National Ministry of Science and Technology, the 13th Five-Year Major Project 2017ZX10203201002-002

  • 摘要:   目的  探讨高密度脂蛋白胆固醇(HDL-C)与HBV相关慢加急性肝衰竭(HBV-ACLF)预后的关系及其预测价值。  方法  选取苏州大学附属第一医院感染科2015年1月—2019年1月收治的肝病患者,根据病情发展的不同阶段,分为HBV-ACLF组(n=42),肝硬化组(n=30)和慢性肝炎组(n=25),同时选取同期健康者(n=24)作为对照。收集患者一般临床资料,包括性别、年龄、PT、Alb、TBil、SCr、尿素氮(BUN)、TC、TG、HDL-C、LDL-C、MELD评分。其中HBV-ACLF组进一步分为好转组(n=17)与未好转组(n=25),随访时间3个月。不符合正态分布的连续性变量两组间比较采用Mann-Whitney U检验,多组间比较采用Kruskal-Wallis H检验,进一步组内比较采用Wilcoxon秩和检验;影响患者预后的独立危险因素用二元logistic回归分析,受试者工作特征曲线(ROC曲线)用于分析预测变量的准确性。  结果  肝硬化组、HBV-ACLF组、慢性肝炎组、健康组在PT、Alb、BUN、TBil、TC、TG、HDL-C、LDL-C、MELD评分上差异均有统计学意义(χ2值分别为75.134、44.638、10.253、80.357、55.067、19.858、68.174、52.492、64.359,P值均<0.05)。各组间进一步两两比较发现,HDL-C水平在HBV-ACLF组[0.12(0.08~0.30)mmol/L]明显低于肝硬化组[0.79(0.60~1.01)mmol/L]、慢性肝炎组[1.06(0.88~1.44) mmol/L]、健康组[2.03(1.36~2.98)mmol/L](Z值分别为3.821、5.921、7.228,P值均<0.001)。HBV-ACLF好转组HDL-C水平明显高于未好转组[0.20(0.11~0.49)mmol/L vs 0.10(0.07~0.15)mmol/L,Z =-1.628,P=0.014]。进一步二元logistic回归,发现HDL-C(OR=0.003,95%CI:0~0.548,P=0.029)与MELD评分(OR=1.588,95%CI:1.032~2.443,P=0.035)是影响HBV-ACLF预后的独立危险因素。HDL-C对HBV-ACLF预后预测的ROC曲线下面积(AUC)为0.807,截断值为0.175 mmol/L,敏感度0.706,特异度0.800,95%CI:0.677~0.937,P=0.001;MELD对HBV-ACLF预后预测的AUC为0.822,截断值为26.500,敏感度0.760,特异度0.765,95%CI:0.696~0.928,P<0.001。  结论  HDL-C是HBV-ACLF患者预后的独立危险因素,在HBV-ACLF预后中具有良好的预测价值。

     

  • 图  1  HDL-C、MELD评分对HBV-ACLF预后预测的ROC曲线

    表  1  一般临床资料

    指标 肝硬化组(n=30) HBV-ACLF组(n=42) 慢性肝炎组(n=25) 健康组(n=24) χ2 P
    男/女(例) 21/9 24/18 16/9 12/12 5.230 0.162
    年龄(岁) 43(39~56) 47(37~58) 37(31~43) 45(20~53) 4.930 0.178
    PT(s) 16.0(14.2~18.3) 25.2(20.0~32.7) 12.0(11.2~13.2) 10.8(10.2~12.0) 75.134 <0.001
    Alb(g/L) 29.6(25.8~32.5) 30.9(27.9~33.2) 46.8(42.9~51.1) 39.0(36.0~43.0) 44.638 <0.001
    Cr(μmol/L) 66.3(52.1~89.7) 60.5(50.2~72.2) 65.4(55.3~73.0) 68.0(59.0~76.0) 2.717 0.437
    BUN(mmol/L) 6.2(4.3~9.7) 3.9(3.0~5.4) 4.6(3.9~5.3) 4.9(4.1~6.4) 10.253 0.017
    TBil(μmol/L) 43.0(20.4~54.4) 305.0(230.3~448.1) 14.2(10.6~18.1) 7.8(5.6~12.3) 80.357 <0.001
    TC(mmol/L) 3.3(2.7~4.3) 2.6(2.0~3.0) 4.3(3.8~4.8) 4.5(3.9~5.0) 55.067 <0.001
    TG(mmol/L) 0.80(0.64~0.96) 1.13(0.84~1.49) 1.41(0.95~1.69) 1.49(1.31~1.62) 19.858 <0.001
    HDL-C(mmol/L) 0.79(0.60~1.01) 0.12(0.08~0.30) 1.06(0.88~1.44) 2.03(1.36~2.98) 68.174 <0.001
    LDL-C(mmol/L) 1.72(1.28~2.00) 1.21(0.75~1.43) 2.46(1.92~2.84) 2.49(1.94~2.89) 52.492 <0.001
    MELD评分 13(12~16) 28(23~30) 6(6~10) - 64.359 <0.001
    下载: 导出CSV

    表  2  HBV-ACLF组不同预后患者临床资料比较

    指标 好转组(n=17) 未好转组(n=25) 统计值 P
    男/女(例) 12/5 18/7 χ2=1.874 0.185
    年龄(岁) 41(34~47) 52(40~61) Z=-2.424 0.015
    PT(s) 21.2(17.4~25.6) 29.8(21.7~33.3) Z=-2.666 0.008
    Alb(g/L) 30.0(27.7~33.8) 31.6(27.8~33.2) Z=-0.282 0.778
    Cr(μmol/L) 57.1(49.2~70.1) 62.6(51.3~72.4) Z=-0.795 0.427
    BUN(mmol/L) 4.0(3.0~5.6) 3.8(3.1~5.5) Z=-0.167 0.868
    TBil(μmol/L) 280.0(182.7~480.1) 347.5(240.4~440.8) Z=-0.653 0.513
    TC(mmol/L) 2.7(2.2~3.4) 2.5(2.0~2.9) Z=-1.281 0.200
    TG(mmol/L) 1.21(0.82~1.68) 1.08(0.83~1.21) Z=-1.487 0.137
    HDL-C(mmol/L) 0.20(0.11~0.49) 0.10(0.07~0.15) Z=-2.452 0.014
    LDL-C(mmol/L) 1.22(0.93~1.66) 1.00(0.69~1.34) Z=-1.628 0.104
    MELD评分 24(22~28) 28(25~30) Z=-2.720 0.007
    下载: 导出CSV

    表  3  HBV-ACLF预后影响因素分析

    指标 OR 95%CI P
    年龄 1.071 0.997~1.150 0.059
    PT 0.986 0.818~1.189 0.883
    HDL-C 0.003 0~0.548 0.029
    MELD评分 1.588 1.032~2.443 0.035
    下载: 导出CSV
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  • 收稿日期:  2020-11-28
  • 修回日期:  2021-01-21
  • 刊出日期:  2021-07-20
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