抗凝血酶Ⅲ活性与慢加急性肝衰竭患者人工肝治疗结局的相关性

Study on the correlation between antithrombin III activity and short-term prognosis of acute-on-chronic liver failure patients treated with artificial liver support system

目的分析抗凝血酶Ⅲ活性与慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)患者行人工肝治疗短期疗效及预后的相关性。方法回顾性分析2012年1月1日至2019年6月30日无锡市第五人民医院感染科ICU收治的236例行人工肝治疗的ACLF患者。记录患者入院时的血常规、肝功能、国际标准化比值(international normalized ratio,INR)、抗凝血酶Ⅲ活性等指标,计算入院时MELD评分,评价人工肝治疗后30 d疗效、90 d生存结局。计量资料采用t检验,计数资料采用卡方检验,不符合正态分布的计量资料采用秩和检验。Logistic回归分析人工肝疗效和患者结局的影响因素。结果人工肝治疗有效139例,90 d死亡63例。回归分析提示抗凝血酶Ⅲ活性(OR=1.118,95%CI 1.082~1.156,P<0.01)是影响人工肝疗效的独立影响因素;TBil(OR=1.008,95%CI 1.004~1.012,P<0.01)、INR(OR=1.109,95%CI 1.076~1.505,P=0.025)、AT-Ⅲ活性(OR=0.911,95%CI 0.881~0.943,P<0.01)、MELD评分(OR=1.090,95%CI 1.052~1.115,P=0.034)是影响患者90 d结局的独立影响因素。结论抗凝血酶Ⅲ活性与ACLF患者行人工肝治疗短期疗效及短期预后有相关性。

Objective To analyze the correlation of antithrombin III(AT-III)activity with short-term efficacy and prognosis of acute-on-chronic liver failure(ACLF)patients treated with artificial liver support system.Methods A retrospective analysis was performed in 236 ACLF patients treated with artificial liver support system in our hospital from January 1,2012 to June 30,2019.The blood routine,liver function,international normalized ratio(INR),and AT-Ⅲactivity were recorded,and the model for end-stage liver disease(MELD)score was calculated at the time of admission.The 30-day efficacy and 90-day survival rate of artificial liver support were evaluated.The t-test and rank sum test were used for measurement data,and the chi-square test was used for count data.The influential factors for the efficacy of artificial liver and patient outcome were analyzed by Logistic regression.Results Artificial liver support was effective in 139 patients,and 63 patients died during the 90-day follow-up.Regression analysis showed that AT-Ⅲactivity(OR=1.118,95%CI 1.082-1.156,P=0.000)was an independent factor affecting the efficacy of artificial liver.Total bilirubin(OR=1.008,95%CI 1.004-1.012,P=0.000),INR(OR=1.109,95%CI 1.076-1.505,P=0.025),AT-Ⅲactivity(OR=0.911,95%CI 0.881-0.943,P=0.000),and MELD score(OR=1.090,95%CI 1.052-1.115,P=0.034)were independent factors affecting the 90-day survival of ACLF patients.Conclusion The short-term efficacy of artificial liver support system and short-term prognosis of ACLF was correlated with AT-Ⅲactivity.