血清胱抑素C联合总胆红素对慢加急性肝衰竭患者短期预后的预测价值

Prognostic value of combined serum cystatin C and total bilirubin in patients with acute-on-chronic liver failure

目的探讨血清胱抑素C(CysC)联合总胆红素(TBil)对乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者短期预后的预测价值。方法入选2012年1月至2016年1月在西京消化病医院住院且资料完整的HBV-ACLF患者,统计患者入院24 h内的一般资料、各项临床检测指标、Child-Turcotte-Pugh评分(CTP评分)、终末期肝病模型评分(MELD评分),所有患者均随访90 d,根据转归分为生存组和死亡组,Logistic多因素回归分析影响患者预后的独立危险因素。结果 162例患者中死亡78例,血清CysC、TBil是影响HBV-ACLF患者生存的独立危险因素。血清CysC与血肌酐(Cr)、MELD评分呈正相关,Spearman相关系数分别为0.400、0.416,均P<0.01。联合血清CysC与TBil组成的预后模型(PM)的ROC曲线下面积(AUC)为0.833,其早期预测HBV-ACLF患者90 d死亡与否的价值高于CTP评分、MELD评分(P<0.05)。高危组(PM≥3.07)90 d生存率为23.8%,低危组(PM<3.07)为79.3%(P<0.01)。结论血清CysC联合TBil建立的预后模型是一个简单易用的评分模型,且对HBV-ACLF患者90 d病死率的预测作用优于CTP和MELD评分。

Objective To investigate the prognostic value of combined serum cystatin C（CysC）and total bilirubin（TBil）for patients with hepatitis B virus-related acute-on-chronic liver failure（HBV-ACLF）.Methods In the retrospective analysis,162 patients with HBV-ACLF admitted in our hospital from January 2012 to January 2016 were enrolled.Baseline clinical information,laboratory examination results,Child-Turcotte-Pugh（CTP）score and model for end-stage liver disease（MELD）score were collected within 24 h after admission.All patients were followed up for 90 days and divided into survival and death groups according to prognoses. Multivariate logistic regression analysis was applied to identify independent risk factors.Results Seventy-eight（48.2%）patients died during the 90-day follow-up.Serum CysC and TBil were independent predictors for mortality（P〈0.01）.Additionally,serum CysC was positively correlated with serum creatinine（Cr）（r=0.400,P〈0.001）and MELD score（r=0.416,P〈0.001）,respectively.In the combination prognostic model（PM）of serum CysC and TBil,area under the receiver operating characteristic curve was 0.833,suggesting that PM had a higher predictive value than CTP and MELD score for 90-day mortality in HBV-ACLF patients.The survival rate in high risk group（PM ≥3.07）was 23.8%,which was markedly lower than that in low risk group（PM〈3.07）（79.3%,P〈0.001）.Conclusion The combination prognostic model of CysC and TBil is superior to the only CTP score or MELD score in predicting 90-day mortality for HBV-ACLF patients.