中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

失代偿期乙型肝炎肝硬化并发肝性脑病患者30天内死亡影响因素分析

黄云义 时克 王宪波

引用本文:
Citation:

失代偿期乙型肝炎肝硬化并发肝性脑病患者30天内死亡影响因素分析

DOI: 10.12449/JCH240313
基金项目: 

国家中医药管理局高水平中医药重点学科建设项目 (zyyzdxk-2023005)

伦理学声明:本研究于2021年3月10日经北京地坛医院伦理委员会批准,批号:京地伦研字(2021)第(002)-01号。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:黄云义负责收集资料,撰写论文;时克负责修改论文;王宪波负责课题设计,指导监督。
详细信息
    通信作者:

    王宪波, wangxianbo638@163.com (ORCID: 0000-0002-3593-5741)

Influencing factors for death within 30 days in patients with decompensated hepatitis B cirrhosis and hepatic encephalopathy

Research funding: 

State Administration of Traditional Chinese Medicine High-Level Key Discipline Construction Project (zyyzdxk-2023005)

More Information
  • 摘要:   目的  探讨乙型肝炎肝硬化失代偿期并发肝性脑病患者30天内死亡的影响因素。  方法  回顾性收集2008年1月—2018年4月北京地坛医院乙型肝炎肝硬化并发肝性脑病患者616例,随访观察30天,根据患者预后将其分为生存组(n=488)与死亡组(n=128)。计量资料两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ2检验或Fisher精确检验。采用Cox回归分析探讨乙型肝炎肝硬化并发肝性脑病患者30天内死亡的独立危险因素。  结果  Cox多因素回归分析显示,年龄(HR=1.029,95%CI:1.014~1.044,P<0.001)、MELD评分(HR=1.118,95%CI:1.098~1.139,P<0.001)及中性粒细胞与淋巴细胞比值(NLR)(HR=1.036,95%CI:1.015~1.057,P=0.001)是乙型肝炎肝硬化并发肝性脑病患者30天内死亡的独立危险因素。分层分析显示,当MELD评分≥20分与NLR≥4时,患者死亡风险较高,30天内的病死率为57.1%(80/140);MELD评分<20分与NLR<4时,30天内的病死率为3.9%(9/232)。  结论  年龄、MELD评分及NLR是影响乙型肝炎肝硬化并发肝性脑病患者30天内死亡的独立危险因素,MELD评分≥20分与NLR≥4的患者30天内的死亡风险较高。

     

  • 图  1  年龄、NLR、MELD评分预测30天预后的ROC曲线

    Figure  1.  ROC curve of age,NLR and MELD score

    图  2  MELD评分及NLR散点图

    Figure  2.  MELD scores and NLR scatter plot

    表  1  生存组与死亡组患者的基线特征

    Table  1.   Baseline characteristics of patients in the survival and death groups

    组别 生存组(n=488) 死亡组(n=128) 统计值 P
    性别(男/女,例) 389/99 96/32 χ2=1.345 0.246
    年龄(岁) 52(45~59) 54(46~62) Z=2.224 0.030
    GIB[例(%)] 154(31.6) 51(39.8) χ2=3.136 0.077
    SBP[例(%)] 29(5.9) 14(10.9) χ2=3.896 0.048
    ALT(U/L) 34.35(21.73~64.40) 124.90(49.23~390.15) Z=7.189 <0.001
    AST(U/L) 50.95(31.50~98.70) 176.40(78.43~399.78) Z=8.661 <0.001
    TBil(μmol/L) 46.00(24.70~111.28) 251.25(102.93~440.93) Z=11.423 <0.001
    Alb(g/L) 28.80(25.10~32.10) 27.35(24.00~31.30) Z=-2.776 0.016
    WBC(×109/L) 5.06(3.14~7.44) 7.81(5.53~12.56) Z=8.473 <0.001
    NLR 3.63(2.24~6.25) 6.69(4.25~11.99) Z=6.765 <0.001
    Hb(g/L) 105.00(81.00~124.30) 109.70(83.40~131.85) Z=1.928 0.053
    PLT(×109/L) 67.50(46.00~103.00) 66.50(42.50~115.75) Z=0.091 0.918
    INR 1.49(1.32~1.87) 2.18(1.77~3.01) Z=11.369 <0.001
    Na+(mmol/L) 137.4(133.7~140.6) 133.3(128.2~137.5) Z=-6.483 <0.001
    肌酐(μmol/L) 67.00(54.33~86.15) 84.40(61.23~140.43) Z=6.207 <0.001
    GLU(mmol/L) 7.60(5.87~10.39) 7.33(5.89~10.88) Z=0.009 0.850
    NH3(μmol/L) 37.0(26.0~49.0) 36.0(26.0~50.4) Z=2.117 0.653
    MELD评分(分) 12.63(8.30~19.43) 26.0(20.70~31.78) Z=14.045 <0.001
    注:GIB,食管胃底静脉曲张出血;GLU,空腹血糖;NH3,血氨。
    下载: 导出CSV

    表  2  患者30天内预后影响因素的Cox回归分析

    Table  2.   Cox regression analysis of prognostic factors within 30 days

    组别 单因素分析 多因素分析
    HR(95%CI) P HR(95%CI) P
    性别(男/女) 1.257(0.843~1.876) 0.262
    年龄(岁) 1.019(1.003~1.035) 0.021 1.029(1.014~1.044) <0.001
    GIB(是/否) 1.410(0.990~2.009) 0.057
    SBP(是/否) 1.656(0.951~2.885) 0.075
    ALT(U/L) 1.001(1.001~1.001) <0.001
    AST(U/L) 1.001(1.001~1.001) <0.001
    TBil(μmol/L) 1.059(1.048~1.071) <0.001
    Alb(g/L) 0.948(0.916~0.981) 0.002
    WBC(×109/L) 1.114(1.088~1.140) <0.001
    NE(×109/L) 1.135(1.105~1.166) <0.001
    LY(×109/L) 1.106(0.869~1.407) 0.412
    NLR 1.062(1.044~1.080) <0.001 1.036(1.015~1.057) 0.001
    Hb(g/L) 1.005(0.999~1.011) 0.008
    PLT(×109/L) 1.000(0.997~1.003) 0.966
    INR 2.280(1.968~2.641) <0.001
    Na+(mmol/L) 0.925(0.904~0.947) <0.001
    肌酐(μmol/L) 1.004(1.003~1.006) <0.001
    GLU(mmol/L) 1.002(0.970~1.036) 0.896
    NH3(μmol/L) 1.010(1.003~1.018) 0.009
    MELD评分(分) 1.121(1.101~1.141) <0.001 1.118(1.098~1.139) <0.001
    注:LY,淋巴细胞计数。
    下载: 导出CSV
  • [1] VILSTRUP H, AMODIO P, BAJAJ J, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver[J]. Hepatology, 2014, 60( 2): 715- 735. DOI: 10.1002/hep.27210.
    [2] Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the management of hepatic encephalopathy in cirrhosis[J]. J Clin Hepatol, 2018, 34( 10): 2076- 2089. DOI: 10.3969/j.issn.1001-5256.2018.10.007.

    中华医学会肝病学分会. 肝硬化肝性脑病诊疗指南[J]. 临床肝胆病杂志, 2018, 34( 10): 2076- 2089. DOI: 10.3969/j.issn.1001-5256.2018.10.007.
    [3] BUSTAMANTE J, RIMOLA A, VENTURA PJ, et al. Prognostic significance of hepatic encephalopathy in patients with cirrhosis[J]. J Hepatol, 1999, 30( 5): 890- 895. DOI: 10.1016/s0168-8278(99)80144-5.
    [4] JEPSEN P, OTT P, ANDERSEN PK, et al. Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study[J]. Hepatology, 2010, 51( 5): 1675- 1682. DOI: 10.1002/hep.23500.
    [5] MUMTAZ K, ISSAK A, PORTER K, et al. Validation of risk score in predicting early readmissions in decompensated cirrhotic patients: a model based on the administrative database[J]. Hepatology, 2019, 70( 2): 630- 639. DOI: 10.1002/hep.30274.
    [6] BAJAJ JS, HAFEEZULLAH M, HOFFMANN RG, et al. Navigation skill impairment: Another dimension of the driving difficulties in minimal hepatic encephalopathy[J]. Hepatology, 2008, 47( 2): 596- 604. DOI: 10.1002/hep.22032. PMID: 18000989.
    [7] SUK KT, BAIK SK, YOON JH, et al. Revision and update on clinical practice guideline for liver cirrhosis[J]. Korean J Hepatol, 2012, 18( 1): 1- 21. DOI: 10.3350/kjhep.2012.18.1.1.
    [8] XU XY, DING HG, LI WG, et al. Chinese guidelines on management of hepatic encephalopathy in cirrhosis[J]. World J Gastroenterol, 2019, 25( 36): 5403- 5422. DOI: 10.3748/wjg.v25.i36.5403.
    [9] UMAPATHY S, DHIMAN RK, GROVER S, et al. Persistence of cognitive impairment after resolution of overt hepatic encephalopathy[J]. Am J Gastroenterol, 2014, 109( 7): 1011- 1019. DOI: 10.1038/ajg.2014.107.
    [10] HU XP, GAO J. International normalized ratio and Model for End-stage Liver Disease score predict short-term outcome in cirrhotic patients after the resolution of hepatic encephalopathy[J]. World J Gastroenterol, 2019, 25( 26): 3426- 3437. DOI: 10.3748/wjg.v25.i26.3426.
    [11] TANDON P, KUMAR D, SEO YS, et al. The 22/11 risk prediction model: a validated model for predicting 30-day mortality in patients with cirrhosis and spontaneous bacterial peritonitis[J]. Am J Gastroenterol, 2013, 108( 9): 1473- 1479. DOI: 10.1038/ajg.2013.204.
    [12] ZAHOREC R. Neutrophil-to-lymphocyte ratio. Sixteen-year-long history since publication of our article in Bratislava Medical Journal[J]. Bratisl Lek Listy, 2017, 118( 6): 321- 323. DOI: 10.4149/BLL_2017_062.
    [13] SHI K, HUANG Y, ZHANG Q, et al. Neutrophil-lymphocyte ratio and the risk of 30-day mortality in patients with overt hepatic encephalopathy[J]. Eur J Gastroenterol Hepatol, 2022, 34( 5): 529- 536. DOI: 10.1097/MEG.0000000000002368.
  • 加载中
图(2) / 表(2)
计量
  • 文章访问数:  98
  • HTML全文浏览量:  54
  • PDF下载量:  30
  • 被引次数: 0
出版历程
  • 收稿日期:  2023-06-02
  • 录用日期:  2023-07-31
  • 出版日期:  2024-03-20
  • 分享
  • 用微信扫码二维码

    分享至好友和朋友圈

目录

    /

    返回文章
    返回