血小板计数及相关评分模型对HBV相关慢加急性肝衰竭预后的预测价值

涂颖; 李雪; 陈美娟; 徐华谦; 汤善宏

doi:10.3969/j.issn.1001-5256.2023.06.009

血小板计数及相关评分模型对HBV相关慢加急性肝衰竭预后的预测价值

DOI: 10.3969/j.issn.1001-5256.2023.06.009

涂颖^{1, 2, 3},
李雪²,
陈美娟^{1, 2},
徐华谦²,
汤善宏^{1, 2, , ,}

1.
西南医科大学临床医学院消化内科，四川泸州 646000
2.
西部战区总医院消化内科，成都 610083
3.
成都市龙泉驿区第一人民医院消化内科，成都 610100

基金项目:

四川省卫健委科研课题 (20PJ180)

伦理学声明：本研究方案于2020年7月9日经由西部战区总医院伦理委员会审批，批号：2020ky005。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：涂颖、李雪负责研究设计，数据收集与分析，稿件撰写；陈美娟负责数据收集与分析；徐华谦负责数据分析，稿件修改；汤善宏负责研究设计与把控，并最终定稿。

详细信息

通信作者:
汤善宏，tangshanhong@swjtu.edu.cn (ORCID: 0000-0001-6652-2942)

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出版历程
- 收稿日期: 2022-11-30
- 录用日期: 2022-12-26
- 出版日期: 2023-06-20

Value of platelet count and related scoring models in predicting the prognosis of hepatitis B virus-related acute-on-chronic liver failure

Ying TU^{1, 2, 3},
Xue LI²,
Meijuan CHEN^{1, 2},
Huaqian XU²,
Shanhong TANG^{1, 2
, ,
,}

1.
Department of Gastroenterology, School of Clinical Medicine, Southwest Medical University, Luzhou, Sichuan 646000, China
2.
Department of Gastroenterology, The General Hospital of Western Theater Command, Chengdu 610083, China
3.
Department of Gastroenterology, The First People's Hospital of Longquanyi District, Chengdu 610100, China

Research funding:

The Science Foundations of Health Commission of Sichuan Province (20PJ180)

More Information

Corresponding author: TANG shanhong, tangshanhong@swjtu.edu.cn (ORCID: 0000-0001-6652-2942)

摘要

摘要: 目的探究血小板(PLT)计数与HBV相关慢加急性肝衰竭(HBV-ACLF)预后的相关性，建立新的PLT相关评分模型并评估其在HBV-ACLF短期预后中的预测价值。方法选取2018年1月—2022年1月于西部战区总医院消化内科住院治疗的HBV-ACLF患者作为回顾性研究队列。收集所有患者入院24 h内的临床资料，根据随访180天后的生存情况将患者分为生存组和死亡组。符合正态分布的计量资料组间比较采用成组t检验；不符合正态分布的计量资料组间比较采用Mann-Whitney U检验；计数资料组间比较采用χ²检验。采用Pearson相关系数分析各指标之间相关性。采用Logistic回归模型进行预后影响因素分析。采用受试者工作曲线评估预后模型预测价值。通过Kaplan-Meier曲线分析患者生存情况。结果共纳入236例患者，180天生存率为75.85%(179/236)。死亡组年龄[(53.98±10.45)岁vs (47.44±12.46)岁，P=0.001]、INR[1.78(1.46~2.04) vs 1.47(1.23~1.68)，P＜0.001]、TBil[275.60(165.00~451.45) μmol/L vs 230.60(154.90~323.70) μmol/L，P=0.035]、MELD评分[21.47(18.14~24.76)分vs 18.67(15.70~21.62)分，P＜0.001]、ALBI评分[-1.06(-1.64~-0.86)分vs-1.32(-1.73~-1.01)分，P=0.034] 高于生存组，PLT水平[80.00(50.00~124.50)×10⁹/L vs 115.00(82.00~143.00)×10⁹/L，P=0.001]、PWR[13.40(9.54~20.70) vs 18.49(13.95~24.74)，P=0.001]低于生存组，差异均有统计学意义。Pearson相关性分析显示，PLT与肝硬化的发生及INR呈负相关(r值分别为-0.332、-0.194，P值分别为＜0.001、0.003)。多因素Logistic回归分析显示，年龄、PLT、INR为HBV-ACLF患者180天预后的独立影响因素(OR值分别为1.045、0.990、2.591，95%CI分别为1.015~1.076、0.983~0.998、1.363~4.925)。获得新的预测模型：AIP=0.006×年龄+0.187×INR-0.001×PLT。AIP评分模型对预测HBV-ACLF患者180天生存率曲线下面积(AUC)为0.718 (敏感度为81.1%，特异度为54.1%)，而PLT、PWR、LPACLF评分、MELD评分、ALBI评分的AUC分别为0.673、0.659、0.588、0.647、0.578。AIP评分模型的cut-off值为0.48。Kaplan-Meier生存分析发现，高AIP评分组的生存率明显低于低AIP评分组(P＜0.001)。结论 PLT相关评分模型对HBV-ACLF预后的预测价值优于其他模型，高PLT水平HBV-ACLF患者的整体生存率更高。
- 慢加急性肝衰竭 /
- 乙型肝炎病毒 /
- 血小板 /
- 预后
Abstract: Objective To investigate the association between platelet count (PLT) and the prognosis of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF), to establish a new PLT-related scoring model, and to assess its value in predicting the short-term prognosis of HBV-ACLF. Methods A retrospective cohort study was conducted among the patients with HBV-ACLF who were hospitalized and treated in Department of Gastroenterology, The General Hospital of Western Theater Command, from January 2018 to January 2022. Clinical data within 24 hours after admission were collected from all patients, and according to the survival after 180 days of follow-up, the patients were divided into survival group and death group. The independent-samples t test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. The Pearson correlation coefficient was used to investigate the correlation between different indicators, and the logistic regression model was used to analyze the influencing factors for prognosis. The receiver operating characteristic (ROC) curve was used to assess the predictive value of the prognostic model, and the Kaplan-Meier curve analysis was used to investigate the survival condition of the high AIP group and the low AIP group. Results A total of 236 patients were enrolled, with a 180-day survival rate of 75.85% (179/236). Compared with the survival group, the death group had significantly higher age (53.98±10.45 vs 47.44±12.46, P=0.001), international normalized ratio (INR) [1.78 (1.46-2.04) vs 1.47 (1.23-1.68), P < 0.001], total bilirubin [275.60 (165.00-451.45) vs 230.60 (154.90-323.70), P=0.035], Model for End-Stage Liver Disease (MELD) score [21.47 (18.14-24.76) vs 18.67 (15.70-21.62), P < 0.001], and albumin-bilirubin (ALBI) score [-1.06 (-1.64~-0.86) vs-1.32 (-1.73~-1.01), P=0.034], as well as significantly lower PLT [80.00 (50.00~124.50) vs 115.00 (82.00~143.00), P=0.001] and platelet-to-white blood cell ratio (PWR) [13.40 (9.54~20.70) vs 18.49 (13.95~24.74), P=0.001]. The Pearson correlation analysis showed that PLT was negatively correlated with liver cirrhosis and INR (r=-0.332 and -0.194, P < 0.001 and P=0.003). The multivariate logistic regression analysis showed that age (odds ratio [OR]=1.045, 95% confidence interval [CI]: 1.015-1.076), PLT (OR=0.990, 95%CI: 0.983-0.998), and INR (OR=2.591, 95%CI: 1.363-4.925) were independent risk factors for the 180-day prognosis of HBV-ACLF patients. The new predictive model was established as follows: AIP=0.006×age+0.187×INR-0.001×PLT. The AIP scoring model had an area under the ROC curve (AUC) of 0.718 in predicting the 180-day prognosis of HBV-ACLF patients, with a sensitivity of 81.1% and a specificity of 54.1%, while PLT, PWR, LPACLF score, MELD score, and ALBI score had an AUC of 0.673, 0.659, 0.588, 0.647, and 0.578, respectively. The AIP scoring model had an optimal cut-off value of 0.48. The Kaplan-Meier survival analysis showed that the high AIP group had a significantly lower survival rate than the low AIP group (P < 0.001). Conclusion The PLT-related scoring model has a better value than other models in predicting the prognosis of HBV-ACLF, and HBV-ACLF patients with a relatively high PLT level tend to have a high overall survival rate.
- Acute-on-Chronic Liver Failure /
- Hepatitis B virus /
- Blood Platelets /
- Prognosis

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图 1 AIP评分与MELD、ALBI评分对HBV-ACLF预后的ROC曲线

Figure 1. Prognostic ROC curve of PLT and related models, MELD and ALBI models for HBV-ACLF

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图 2 不同AIP评分组的无移植存活率比较

Figure 2. Comparison of transplant-free survival rate among different AIP groups

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表 1 两组HBV-ACLF患者临床特征比较

Table 1. Comparison of characteristics of HBV-ACLF patients in survival group and death group

指标	生存组(n=179)	死亡组(n=57)	统计值	P值
年龄(岁)	47.44±12.46	53.98±10.45	t=-3.322	0.001
男性[例(%)]	145(81.00)	41(71.93)	χ²=0.144	0.147
PLT(×10⁹/L)	115.00(82.00~143.00)	80.00(50.00~124.50)	Z=-3.799	0.001
WBC(×10⁹/L)	5.78(4.45~7.68)	5.73(4.42~7.93)	Z=-0.254	0.711
Neu(×10⁹/L)	4.08(2.82~5.48)	4.37(3.20~6.09)	Z=-0.756	0.709
PT(s)	16.75(14.00~18.93)	20.00(16.45~22.70)	Z=-4.188	0.224
INR	1.47(1.23~1.68)	1.78(1.46~2.04)	Z=-4.254	＜0.001
Alb(g/L)	33.90(30.90~38.30)	32.74(28.90~37.10)	Z=-1.582	0.278
TBil(μmol/L)	230.60(154.90~323.70)	275.60(165.00~451.45)	Z=-1.732	0.035
ALT(U/L)	282.80(104.85~901.55)	434.10(138.80~1 117.20)	Z=-1.279	0.281
AST(U/L)	338.70(105.75~924.80)	364.30(141.80~819.20)	Z=-0.632	0.530
AFP(μg/L)	54.27(13.71~163.84)	25.54(5.93~122.84)	Z=-2.029	0.266
Cre(μmol/L)	73.00(62.00~86.00)	70.00(61.50~88.00)	Z=-0.268	0.697
PWR	18.49(13.95~24.74)	13.40(9.54~20.70)	Z=-3.376	0.001
LPACLF评分	-6.99(-7.85~-4.58)	-6.59(-7.22~-4.55)	Z=-1.862	0.063
MELD评分	18.67(15.70~21.62)	21.47(18.14~24.76)	Z=-3.499	＜0.001
ALBI评分	-1.32(-1.73~-1.01)	-1.06(-1.64~-0.86)	Z=-2.120	0.034

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表 2 HBV-ACLF患者180天预后多因素Logistic分析

Table 2. Multivariate Logistic analysis of 180-day prognosis of HBV-ACLF patients

指标	β	SE	OR(95%CI)	P值
年龄	0.006	0.015	1.045(1.015~1.076)	0.003
PLT	-0.001	0.004	0.990(0.983~0.998)	0.010
INR	0.187	0.328	2.591(1.363~4.925)	0.004
TBil	0.001	0.001	1.001(0.999~1.004)	0.211

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表 3 AIP评分与MELD、ALBI评分对HBV-ACLF预后的预测价值比较

Table 3. Comparison of prognostic value of PLT and related models, MELD and ALBI models for HBV-ACLF

评分模型	AUC	cut-off值	约登指数	敏感度	特异度
PLT	0.673	99.50	0.352	0.698	0.656
PWR	0.659	13.41	0.328	0.509	0.819
LPACLF	0.588	-7.24	0.211	0.792	0.419
MELD	0.647	20.21	0.304	0.660	0.644
ALBI	0.578	-1.03	0.247	0.491	0.756
AIP	0.718	0.48	0.352	0.811	0.541

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