纤维蛋白原是影响HBV相关慢加急性肝衰竭近期预后的独立危险因素

Fibrinogen is an independent risk factor affecting the short-term prognosis of HBV-related acute-on-chronic liver failure

目的比较乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者的血栓弹力图(TEG)及凝血指标在评估患者近期预后方面的价值。方法对福建医科大学孟超肝胆医院2017年5月至2019年1月间收治的117例HBV相关ACLF患者进行回顾性研究,收集患者TEG、凝血功能、生化、血常规等指标;比较生存组和死亡组上述指标的差异;运用多因素logistic回归分析HBV-ACLF的独立危险因素;并用ROC曲线评价独立危险因素对HBV-ACLF患者预后评估的价值。结果死亡组R值、K值、PT、INR、D-D、TBil、AST、Scr水平、HBV DNA载量均明显高于生存组〔死亡组VS生存组:R值为6.60±3.86比4.84±1.4、PT为37.13±14.35比24.60±6.67、INR为3.40(2.57~5.51)比1.84(1.46~2.21)、D-D为5.32(3.51~9.34)比1.78(0.77~4.29)、TBil为366.20(326.95~464.85)比218.45(107.20~330.65)〕(P均<0.05),而CI值、MA值、Angle角、PTA、Fg、PLT水平均低于生存组(死亡组VS生存组:PTA为24.69±12.72比38.84±12.92、Fg为1.04±0.51比1.83±0.62、PLT为108.88±45.60比126.29±46.86)(均P<0.05);且影响HBV-ACLF患者近期预后有统计学意义的变量为TBil(OR:0.993,95%CI:0.987~0.999)及Fg(OR:14.922,95%CI:2.302~96.741);TBil及Fg对HBV-ACLF患者90天生存率评估的AUC分别为0.810(95%CI:0.733~0.886)及0.851(95%CI:0.777~0.925)。结论Fg和TBil为HBV-ACLF患者近期预后的独立危险因素。

Objective To compare and evaluate the value of thromboelastogram(TEG)and coagulation indexes in predicting the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF),and to analyze the independent risk factors affecting the short-term prognosis of HBV-ACLF.Methods A retrospective study was conducted on 117 patients with HBV-related ACLF treated in Mengchao Hepatobiliary Hospital of Fujian Medical University from May 2017 to January 2019.The indexes of TEG,blood coagulation,biochemistry and blood routine were collected;the differences of the above indexes between the survival group and the death group were compared;the independent risk factors of HBV-ACLF were analyzed by multivariate logistic regression;and the value of independent risk factors in evaluating the prognosis of HBV-ACLF patients was evaluated by ROC curve.Results The R value,K value,PT,INR,D-D,TBil,AST,Scr and HBV DNA load in the death group were significantly higher than those in the survival group〔death group VS survival group:R value is 6.60±3.86 vs 4.84±1.4,PT is 37.13±14.35 vs 24.60±6.67,INR is 3.40(2.57-5.51)vs 1.84(1.46-2.21),TBil is 5.32(3.51-9.34)vs 1.78(0.77-4.29),TBil is 366.20(326.95-464.85)vs 218.45(107.20-330.65)〕(all P<0.05),while the CI value,MA value,Angle angle,PTA,Fg and PLT levels in the death group were lower than those in the survival group(death group vs survival group:PTA is 24.69±12.72 vs 38.84±12.92、Fg is 1.04±0.51 vs 1.83±0.62、PLT is 108.88±45.60 vs 126.29±46.86)(all P<0.05).TBil(OR:0.993,95%CI:0.987~0.999)and Fg(OR:14.922,95%CI:2.302~96.741)were statistically significant variables affecting the short-term prognosis of HBV-ACLF patients.The AUC of 90-day survival rate of HBV-ACLF patients evaluated by TBil and Fg were 0.810(95%CI:0.733~0.886)and 0.851(95%CI:0.777~0.925).Conclusion Fg and TBil are independent risk factors for short-term prognosis in patients with HBV-ACLF,and Fg is effective in predicting the short-term prognosis of patients with ACLF.