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乙型肝炎肝硬化患者发生慢性肾病的影响因素分析

杨莉 时克 高方媛 冉崇平 侯杰 王宪波

杨莉,时克,高方媛,等. 乙型肝炎肝硬化患者发生慢性肾病的影响因素分析[J]. 临床肝胆病杂志, 2021, 37(8): 1817-1821. DOI: 10.3969/j.issn.1001-5256.2021.08.015
引用本文: 杨莉,时克,高方媛,等. 乙型肝炎肝硬化患者发生慢性肾病的影响因素分析[J]. 临床肝胆病杂志, 2021, 37(8): 1817-1821. DOI: 10.3969/j.issn.1001-5256.2021.08.015
YANG L, SHI K, GAO FY, et al. Influencing factors for chronic kidney disease in patients with hepatitis B cirrhosis[J]. J Clin Hepatol, 2021, 37(8): 1817-1821. DOI: 10.3969/j.issn.1001-5256.2021.08.015
Citation: YANG L, SHI K, GAO FY, et al. Influencing factors for chronic kidney disease in patients with hepatitis B cirrhosis[J]. J Clin Hepatol, 2021, 37(8): 1817-1821. DOI: 10.3969/j.issn.1001-5256.2021.08.015

乙型肝炎肝硬化患者发生慢性肾病的影响因素分析

DOI: 10.3969/j.issn.1001-5256.2021.08.015
基金项目: 

首都卫生发展科研专项 2018-1-2172

北京市科学技术委员会资助 Z191100006619033

国家中医药管理局重大疑难疾病中西医临床协作试点项目 2018-6-4

国家中医药管理局区域中医诊疗中心建设项目 2019-3-18

详细信息
    通讯作者:

    王宪波,wangxianbo638@163.com

  • 中图分类号: R512.62;R575.2

Influencing factors for chronic kidney disease in patients with hepatitis B cirrhosis

Funds: 

Capital Health Development Research Project 2018-1-2172

Beijing Municipal Commission of Science and Technology Z191100006619033

National Administration of Traditional Chinese Medicine Clinical Cooperation Pilot Project of Traditional Chinese and Western Medicine for Major and Difficult Diseases 2018-6-4

Regional TCM Diagnosis and Treatment Center Construction Project of State Administration of Traditional Chinese Medicine 2019-3-18

  • 摘要:   目的  探讨乙型肝炎肝硬化患者3年内发生慢性肾病(CKD)的影响因素。  方法  纳入2014年1月—2017年7月就诊于首都医科大学附属北京地坛医院的乙型肝炎肝硬化患者376例,随访3年,根据是否发生CKD分为CKD组(n=23)和非CKD组(n=353)。收集患者一般情况和实验室指标。计量资料两组间比较采用t检验或Mann-Whitney U检验。计数资料两组间比较采用χ2检验或Fisher精确概率法。采用多因素Cox逐步向前回归方法,分析乙型肝炎肝硬化患者3年内发生CKD的独立影响因素。采用受试者工作特征曲线下面积(AUC)评估影响因素对乙型肝炎肝硬化患者发生CKD的预测价值,Kalplan-Merier法进行生存分析,log-rank检验比较不同风险患者CKD累积发生率。  结果  Cox多因素分析显示,年龄(HR=1.078,95%CI:1.007~1.114,P=0.026)、Alb(HR=0.923,95%CI:0.860~0.989,P=0.024)、肾小球滤过率(eGFR)(HR=0.977,95%CI:0.955~0.999,P=0.037)是乙型肝炎肝硬化患者3年内发生CKD的独立影响因素。年龄、Alb、eGFR对CKD发生的预测价值较好(受试者工作特征曲线下面积分别为0.701、0.710、0.706)。Kalplan-Merier生存曲线显示,基线年龄≥55岁、Alb<32 g/L、60 ml·min-1·1.73m-2≤eGFR<76 ml·min-1·1.73m-2的患者发生CKD的风险高(χ2值分别为9.647、13.621、30.940,P值均<0.05)。  结论  高龄、低Alb水平及eGFR较低的患者建议密切监测肾功能。

     

  • 图  1  年龄、Alb、eGFR的ROC曲线

    图  2  不同年龄、Alb和eGFR患者CKD发生率

    表  1  CKD组和非CKD组患者基线特征比较

    指标 CKD组(n=23) 非CKD组(n=353) 统计值 P
    年龄(岁) 56.1±10.2 48.7±9.9 t=1.516 <0.001
    男/女(例) 18/5 259/94 χ2=0.011 0.978
    失代偿期肝硬化[例(%)] 19(82.6) 216(61.2) χ2=1.300 0.039
    饮酒史[例(%)] 2(8.7) 54(15.3) χ2=0.647 0.389
    吸烟史[例(%)] 4(17.4) 88(24.9) χ2=1.220 0.415
    腹水[例(%)] 11(47.8) 108(30.6) χ2=3.522 0.152
    上消化道出血[例(%)] 7(30.4) 63(17.8) χ2=0.066 0.181
    肝性脑病[例(%)] 1(4.3) 11(3.1) χ2=0.175 0.077
    ALT(U/L) 36.9(17.9~53.4) 37.0(22.8~75.5) Z=-0.752 0.209
    AST(U/L) 43.8(31.9~71.7) 39.6(26.5~81.3) Z=-0.560 0.053
    TBil(μmol/L) 22.2(15.3~30.5) 22.7(13.8~35.7) Z=5.136 0.521
    Alb(g/L) 27.8(26.0~31.0) 33.2(28.3~38.3) Z=-0.794 0.004
    ALP(U/L) 93.9(68.8~130.1) 79.3(59.7~106.4) Z=-0.199 0.088
    GGT(U/L) 38.2(16.5~76.0) 37.4(19.4~84.5) Z=-0.564 0.336
    TC(mmol/L) 2.7(2.4~3.6) 3.2(2.6~3.9) Z=-1.675 0.230
    TG(mmol/L) 0.6(0.5~1.0) 0.7(0.5~1.0) Z=-0.681 0.104
    HDL(mmol/L) 0.9(0.5~1.2) 0.8(0.5~1.1) Z=-0.802 0.986
    LDL(mmol/L) 1.4(1.1~1.5) 1.6(1.3~2.1) Z=-2.310 0.114
    WBC(×109/L) 4.2(2.8~5.4) 3.6(2.7~5.1) Z=1.180 0.521
    PLT(×109/L) 79.5(44.0~98.4) 72.0(49.0~108.0) Z=0.127 0.583
    BUN(mmol/L) 5.1(4.0~6.5) 5.4(4.2~6.5) Z=0.527 0.217
    Cr(μmoI/L) 71.0(62.0~85.0) 66.0(56.0~75.0) Z=0.302 0.116
    PT(s) 14.9(13.6~16.3) 14.3(12.9~16.0) Z=1.410 0.211
    INR 1.3(1.2~1.4) 1.2(1.1~1.4) Z=0.923 0.523
    HBeAg阳性[例(%)] 10(43.5) 175(49.6) χ2=0.065 0.799
    HBV DNA(log10拷贝/ml) 4.3(2.7~5.7) 3.5(2.7~5.5) Z=-0.105 0.731
    eGFR(ml·min-1·1.73 m-2) 75.9(67.7~106.5) 102.7(87.1~119.5) Z=-0.774 0.016
    下载: 导出CSV

    表  2  乙型肝炎肝硬化患者发生CKD的单因素分析

    因素 HR(95%CI) P
    年龄(岁) 1.090(1.040~1.141) <0.001
    男性 1.009(0.398~2.258) 0.986
    失代偿期肝硬化 2.892(1.048~8.500) 0.045
    吸烟史 0.650(0.221~1.909) 0.433
    饮酒史 0.541(0.127~2.305) 0.406
    腹水 1.421(0.096~1.969) 0.053
    上消化道出血 1.852(0.762~4.502) 0.863
    肝性脑病 0.852(0.215~3.377) 0.819
    ALT(U/L) 0.996(0.991~1.003) 0.215
    AST(U/L) 0.998(0.992~1.002) 0.412
    TBil(μmol/L) 1.002(0.996~1.009) 0.499
    Alb(g/L) 0.904(0.884~0.970) 0.005
    ALP(U/L) 1.008(0.999~1.116) 0.076
    GGT(U/L) 0.996(0.989~1.004) 0.331
    WBC(×109/L) 1.071(0.868~1.321) 0.523
    PLT(×109/L) 0.997(0.988~1.007) 0.583
    BUN(mmol/L) 1.119(0.077~1.328) 0.126
    Cr(μmoI/L) 1.033(0.997~1.062) 0.118
    PT(s) 1.079(0.964~1.208) 0.186
    INR 1.620(0.401~6.565) 0.498
    TC(mmol/L) 0.759(0.482~1.194) 0.223
    TG(mmol/L) 0.387(0.124~1.203) 0.101
    HDL(mmol/L) 0.984(0.337~2.875) 0.997
    LDL(mmol/L) 0.588(0.305~1.135) 0.113
    HBeAg阳性 0.901(0.398~2.043) 0.809
    HBV DNA(log10拷贝/ml) 1.043(0.838~1.299) 0.704
    eGFR(ml·min-1·1.73 m-2) 0.968(0.950~0.984) 0.005
    下载: 导出CSV

    表  3  不同抗病毒药物对CKD发生影响

    抗病毒药物 CKD组
    (n=23)
    非CKD组
    (n=353)
    P
    恩替卡韦(例) 14 194 0.221
    替诺福韦(例) 5 42 0.449
    拉米夫定(例) 0 8
    替比夫定(例) 1 5
    阿德福韦酯(例) 0 13 0.449
    阿德福韦酯+拉米夫定(例) 1 11 0.942
    阿德福韦酯+恩替卡韦(例) 1 19 0.667
    阿德福韦酯→恩替卡韦(例) 0 10
    阿德福韦酯→阿德福韦酯+恩替卡韦(例) 0 13
    拉米夫定→恩替卡韦(例) 1 26 0.406
    其他(例) 0 12
    下载: 导出CSV
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  • 收稿日期:  2021-01-03
  • 修回日期:  2021-01-26
  • 刊出日期:  2021-08-16
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