儿童胆汁淤积性肝病进展为急性肝衰竭的危险因素分析

Analysis of risk factors for the progression to acute liver failure in children with cholestatic liver disease

目的探讨儿童胆汁淤积性肝病(CLD)进展为急性肝衰竭的危险因素,为预测和改善儿童CLD的预后提供参考。方法选取2020年1月至2022年12月于首都儿科研究所附属儿童医院住院治疗的CLD患儿44例,通过电子病历系统收集病例资料并根据出院时的临床转归结果将患儿分为单纯CLD组(25例)及急性肝衰竭组(19例)。采用多因素logistic回归分析探讨CLD患儿发生急性肝衰竭的影响因素,并进一步采用受试者操作特征(ROC)曲线分析上述影响因素对CLD患儿发生急性肝衰竭的预测价值。结果两组患儿性别、年龄、病程、病因比较差异均无统计学意义(P>0.05);与单纯CLD组相比,急性肝衰竭组的白蛋白、血红蛋白、血小板计数更低,降钙素原、国际标准化比值、血氨水平更高,凝血酶原时间、活化部分凝血活酶时间更长,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示降钙素原及活化部分凝血活酶时间是儿童CLD发生急性肝衰竭的独立危险因素(P<0.05),且ROC曲线分析显示两者同时升高对CLD患儿发生急性肝衰竭的预测价值更高(曲线下面积为0.974,敏感度为0.895,特异度为0.960)。结论部分CLD患儿起病后可能会进展至急性肝衰竭,早期应密切监测活化部分凝血活酶时间及降钙素原,特别是对于二者呈进行性升高的重症CLD患儿,应高度警惕急性肝衰竭的发生。

Objective To explore the risk factors for clinical indicators changes in children with cholestatic liver disease(CLD)progressing to acute liver failure,providing reference for predicting and improving the prognosis of CLD in children.Method 44 children with CLD who were hospitalized in Children’s Hospital Capital Institute of Pediatrics from January 2020 to December 2022 were selected.The case data of the children were collected through an electronic medical record system,and based on their clinical outcomes at discharge,they were divided into a simple CLD group(25 cases)and an acute liver failure group(19 cases).Using multiple logistic regression analysis to explore the influencing factors of acute liver failure in children with CLD,and further using receiver operating characteristic(ROC)curve to analyze the predictive value of these influencing factors for acute liver failure in children with CLD.Result There was no statistically significant difference in gender,age,disease duration,and etiology between the two groups of patients(P>0.05);Compared with the simple CLD group,the acute liver failure group had lower albumin,hemoglobin,and platelet counts,higher levels of procalcitonin,international standardized ratio,and blood ammonia,and longer prothrombin time and activated partial thromboplastin time,with statistically significant differences(P<0.05).The results of multiple logistic regression analysis showed that procalcitonin and activated partial thromboplastin time were independent risk factors for acute liver failure in children with CLD(P<0.05),and ROC curve analysis showed that the simultaneous increase of both factors had a higher predictive value for acute liver failure in children with CLD(area under the curve was 0.974,sensitivity was 0.895,specificity was 0.960).Conclusion Some children with cholestatic liver disease may progress to acute hepatic failure after the onset of the disease.Therefore,close monitoring of changes in prothrombin time and activated partial thromboplastin time in children with cholestatic liver disease,especially those with progressive elevation of both indicators,should be highly vigilant for the occurrence of acute hepatic failure.Early intervention and treatment are essential to improve prognosis.