低三碘甲腺原氨酸综合征对慢加急性肝衰竭患者短期预后的预测价值

Prognostic value of low triiodothyronine syndrome on short-term prognosis of patients with acute-on-chronic liver failure

目的探究低三碘甲腺原氨酸综合征(low triiodothyronine syndrome,LT_3S)对慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)患者90 d预后的预测价值。方法收集2017年1月至2017年12月期间首都医科大学附属北京地坛医院收治的不合并原发性甲状腺功能异常的慢加急性肝衰竭患者75例,根据90 d生存情况分为生存组(36例)和死亡组(39例),比较两组患者的基线生物化学指标(ALT、AST、TBil、白蛋白、球蛋白、乳酸脱氢酶、γ-谷氨酰转肽酶、碱性磷酸酶、胆碱酯酶、总胆汁酸、总胆固醇、C-反应蛋白、血肌酐、血钠)、凝血指标(国际标准化比值和凝血酶原活动度)、是否合并LT_3S、血小板、MELD评分及并发症(消化道出血、腹腔积液和肝性脑病等),分析LT_3S与ACLF患者90d预后的关系。结果两组患者入院时白蛋白、碱性磷酸酶、总胆汁酸、CRP、PTA和MELD评分的差异有统计学意义(P <0.05),是否合并LT_3S、消化道出血、肝性脑病及肝肾综合征的差异也有统计学意义(P <0.05)。COX多元回归表明,PTA(HR=0.345,95%CI:0.159～0.751)、CRP(HR=1.028,95%CI:1.013～1.043)、LT_3S(HR=1.113,95%CI:1.045～1.186)、MELD评分(HR=1.103,95%CI:1.039～1.170)及肝肾综合征(HR=1.008,95%CI:1.003～1.013)为ACLF患者90d病死的独立危险因素。其中PTA为保护性因素(P=0.007),CRP、MELD评分、合并LT_3S及肝肾综合征为危险因素(P=0.001)。结论低三碘甲腺原氨酸综合征为慢加急性肝衰竭患者短期病死的重要预测因素。

Objective To discuss the prognostic value of low triiodothyronine syndrome(LT3S)on shortterm prognosis of patients with acute-on-chronic liver failure(ACLF).Method A total of 75 ACLF patients without primary thyroid dysfunction in Beijing Ditan Hospital,Capital Medical University from January 2017 to December 2017 were selected.The patients were divided into survival group(36 cases)and dead group(39 cases)according to their survival state during 90 days.Biochemistry indicators(ALT,AST,TBil,albumin,globulin,lactic dehydrogenase,γ-glutamyl transpeptidase,alkaline phosphatase,cholinesterase,total bile acid,total cholesterol,C-reactive protein,serum creatinine and serum natrium),coagulation indicators(international normalized ratio and prothrombin time activity),with or without LT3S,thrombocyte,MELD scores and complications related to ACLF(ascites,hepatic encephalopathy,hepatorenal syndrome and gastrointestinal bleeding)were compared between the two groups and the relationship between LT3S and prognosis was also analyzed.Results The differences of albumin,alkaline phosphatase,total bile acid,C reaction protein,prothrombin activity,MELD score,LT3S,hemorrhage of digestive tract,hepatic encephalopathy and hepatorenal syndrome were statistically significant between survival group and death group(P<0.05).COX survival analysis showed that prothrombin activity(HR=0.345,95%CI:0.159~0.751),C reaction protein(HR=1.028,95%CI:1.013~1.043),LT3S(HR=1.113,95%CI:1.045~1.186),MELD score(HR=1.1033,95%CI:1.039~1.170)and hepato-renal sydrome(HR=1.008,95%CI:1.003~1.013)were independent factors for 90 days of death in patients with ACLF,among which prothrombin activity was the protective factor(P=0.007),C reaction protein,MELD score,LT3S and hepato-renal sydrome were risk factors(P=0.001).Conclusion LT3S is one of the important events of evaluating the prognosis of patients with ACLF.