HBV相关的慢加急性肝衰竭患者肾上腺皮质功能状态对恩替卡韦治疗后临床结局的影响

Effect of adrenocortical kinetic energy on clinical outcome of entecavir in patients with hepatitis B virus related acute-on-chronic liver failure

目的探讨HBV相关的慢加急性肝衰竭(HBV-ACLF)患者肾上腺皮质功能状态对恩替卡韦治疗后临床结局的影响。方法收集2019年1-12月行恩替卡韦治疗的HBV-ACLF患者30例,根据治疗3个月后临床结局将其分为好转组(n=13)与恶化组(n=17)。分别采用单因素和多因素Logistic法分析HBV-ACLF患者预后不良的影响因素。通过绘制受试者工作特征(ROC)曲线评价皮质醇、促肾上腺皮质激素(ACTH)对HBV-ACLF患者预后不良的诊断效能。结果单因素Logistic分析结果示患者年龄,临床分期,HBV DNA水平,血清ALT、AST、凝血酶原活动度、皮质醇、ACTH含量与临床结局相关(P <0.05)。多因素Logistic分析显示,年龄、临床分期、血清皮质醇以及ACTH水平是HBV-ACLF患者预后不良的独立影响因素(P <0.05)。ROC曲线分析发现,皮质醇、ACTH的最佳工作点分别为9.415 nmol·L^(-1)、25.499 ng·L^(-1),灵敏度分别为84.6%、69.2%,特异度分别为69.2%和88.2%,两者联合诊断效能高于单一指标检测。结论血清皮质醇、ACTH水平降低与HBV-ACLF患者行恩替卡韦治疗后预后不良相关。

AIM To investigate the effect of adrenocortical kinetic energy on clinical outcome of entecavir in patients with hepatitis B virus related acute-on-chronic liver failure(HBV-ACLF). METHODS A total of 30 patients with HBV-ACLF treated by entecavir were selected as the research objects, and were retrospectively analyzed from January 2019 to December 2019. According to the clinical outcome after 3 months of treatment, they were divided into improvement group(n=13) and deterioration group(n=17). Univariate and multivariate Logistic analyses were used to analyze the influencing factors of poor prognosis in HBV-ACLF patients. Receiver operating characteristic(ROC) curve was drawn to evaluate the diagnostic efficacy of cortisol and adreno corticotropic hormone(ACTH) in the poor prognosis of HBV-ACLF patients. RESULTS Univariate Logistic analysis showed that age, clinical stage, HBV DNA level, serum levels of ALT, AST, PTA, cortisol and ACTH were associated with clinical outcomes(P < 0.05). Multivariate Logistic analysis showed that age, clinical stage, serum cortisol and ACTH levels were independent factors of poor prognosis in patients with HBV-ACLF(P < 0.05). ROC curve analysis showed that the best working points of cortisol and ACTH were 9.415 nmol·L^(-1) and 25.499 ng·L^(-1), respectively, with the sensitivity of 84.6% and 69.2%, and the specifi city of 69.2% and 88.2%, respectively. The combined diagnostic effi ciency of the two indexes was higher than that of single index detection. CONCLUSION The lower levels of serum cortisol and ACTH are related to the poor prognosis of HBV-ACLF patients treated by entecavir.