HBV感染肝硬化失代偿期患者贫血情况调查及其对预后的影响

Investigate the incidence of anemia and its effect for prediction 1-year mortality in HBV related decompensated cirrhosis patients

目的探讨贫血在HBV感染肝硬化失代偿期(HBV-DC)患者中的发生率及其对HBV-DC患者1年预后影响的研究。方法前瞻性入组2016年1月至2018年12月在中国科学院大学宁波华美医院住院的HBV-DC患者647例,调查患者贫血情况及程度,基线评估指标等,COX生存分析贫血及其严重程度在预测HBV-DC患者1年预后的预测价值。结果647例HBV-DC患者,合并贫血406例,占总人群的62.8%,其中轻度贫血254例(39.3%)、中度贫血122例(18.9%)、重度贫血30例(4.6%)。1年死亡133例,死亡率20.6%。采用COX生存分析发现年龄(风险比,1.033;95%可信区间,1.017~1.049),血红蛋白(风险比,0.992;95%可信区间,0.985-0.999),白细胞计数(风险比,1.069;95%可信区间,1.028-1.111),MELD评分(风险比,1.095;95%可信区间,1.070~1.120)为1年死亡的独立预测因素。合并贫血及不同程度贫血患者1年生存的KM曲线存在明显差异(P<0.001)。结论HBV-DC患者贫血发生率高达62.8%,贫血是HBV-DC患者1年预后的重要影响因素,为临床评估和预后判断提供新思路。

Objective To investigate the prevalence and severity of anemia and its effect on one-year survival in HBV related decompensated cirrhosis patients(HBV-DC).Methods 647 consecutive HBV-DC patients were prospectively enrolled from January 2016 to December 2018 in Hwamei Hospital,University of Chinese Academy of Sciences.Anemia and the baseline characterics of patients were evaluated.Cox regression analysis was used to evaluate the impact on one-year survival.Results Of 647 HBV-DC patients,406 were complicated with anemia,accounting for 62.8%of the total population,including 254 patients with mild anemia(39.3%),122 with moderate anemia(18.9%),and 30 with severe anemia(4.6%).133 died in 1 year,with a mortality rate of 20.6%.On cox regression analysis,age(HR,1.033;95%CI,1.017-1.049),hemoglobin(HR,0.992;95%CI,0.985-0.999),WBC(HR,1.069;CI,1.028-1.111),MELD score(HR,1.095;95%CI,1.070-1.120)were independent associated with 1-year mortality.The 1-year survival KM curve of anemia and its severity was significantly different(P<0.001).Conclusions The incidence of anemia in HBV-DC patients is as high as 62.8%.Anemia and its severity are important factors affecting the one-year prognosis of HBV-DC patients,which provide new ideas for clinical evaluation and prognosis assessment.