血清铁蛋白水平与肝硬化失代偿患者死亡率的相关性研究

Correlation between serum ferritin level and mortality in patients with decompensated liver cirrhosis

目的:探讨血清铁蛋白(SF)水平与肝硬化失代偿患者死亡率的关系。方法:所有患者按照SF水平分为低水平组和高水平组,运用t检验或χ^(2)检验比较2组患者各临床因素,运用Pearson检验对肝硬化失代偿患者血清SF水平与肝肾功和甲胎蛋白进行相关性分析,Kaplan-Meier生存分析比较2组患者随访1年内总生存率,Cox回归分析获得影响肝硬化失代偿患者随访1年内生存情况的独立预测因素。结果:研究共纳入119例肝硬化失代偿患者,其中男80例(67.2%),女39例(32.8%),平均年龄(53.6±13.4)岁,所有患者按照SF水平分为低水平组(<200 ng/mL)和高水平组(≥200 ng/mL),低水平组57例(47.9%),高水平组62例(52.1%),SF高水平组患者消化道出血、Ⅲ度食管胃底静脉曲张以及腹水所占的比例明显高于SF低水平组患者,SF高水平组患者肌酐、总胆红素、Child-Pugh评分以及MELD评分明显高于SF低水平组患者。Pearson相关性分析显示,肝硬化失代偿患者血清SF与肌酐、总胆红素、Child-Pugh评分以及MELD评分呈明显正相关,Kaplan-Meier生存分析显示,SF低水平组患者随访3个月、6个月、12个月总生存率明显高于SF高水平组患者(93.4%、85.6%、56.7%vs.93.4%、82.1%、34.6%,P<0.05)。Cox多因素分析显示,消化道出血、肝性脑病、肌酐、SF、Child-Pugh评分以及MELD评分6个指标为影响肝硬化失代偿患者随访1年内生存情况的独立预测因素,其中SF高水平患者随访1年内死亡的风险是SF低水平患者的1.678倍(HR:1.678,95%CI:1.213~1.994,P=0.037)。结论:SF、Child-Pugh评分和MELD评分可用于预测肝硬化失代偿期患者疾病严重程度和短期预后。

Objective:To investigate the relationship between serum ferritin(SF)level and mortality in decompensated patients with liver cirrhosis.Methods:All patients were divided into low-level group and high-level group according to SF level,t-test or χ^(2) test was used to compare the clinical factors of the two groups,use the Pearson test to analyze the correlation between serum SF level,liver and kidney function and alpha fetoprotein in patients with decompensated liver cirrhosis,Kaplan Meier survival analysis was used to compare the overall survival rate of decompensated patients with liver cirrhosis between the two groups within one year of follow-up,and Cox regres-sion analysis to obtain the independent predictors of the survival of patients with decompensated liver cirrhosis within one year of follow-up.Results:A total of 119 patients with decompensated liver cirrhosis were included in the study,with an average age of(53.6±13.4)years,including 80 males(67.2%)and 39 females(32.8%).All patients were divided into low-level group(<200 ng/mL)and high-level group(≥200 ng/mL)according to SF level,57 cases(47.9%)in low-level group and 62 cases(52.1%)in high-level group.The proportion of gastrointestinal bleeding,grade Ⅲ esophagogastric varices and ascites in the high SF level group was significantly higher than that in the low SF level group.The creatinine,total bilirubin,child Pugh score and MELD score in the high-level SF group were significantly higher than those in the low-level SF group.The Pearson correlation analysis showed that there was a significant positive correlation between serum SF and creatinine,total bilirubin,child Pugh score and MELD score in patients with decompensated liver cirrhosis,Kaplan Meier survival analysis showed that the 3-month,6-month,12-month follow-up overall survival rate of patients with decompensated liver cirrhosis in low SF level group was significantly higher than that of patients in high SF level group(93.4%,85.6%,56.7%vs.93.4%,82.1%,34.6%,P<0.05).Cox multivariate analysis showed that gastrointestinal bleeding,hepatic encephalopathy,creatinine,SF Child-Pugh score and MELD score were independent predictors of survival in patients with decompensated liver cirrhosis during 1-year follow-up.The risk of death in patients with high SF level was 1.678 times higher than that in patients with low SF level(HR:1.678,95%CI:1.213-1.994,P=0.037).Conclusion:SF,Child Pugh score and MELD score can be used to predict the disease severity and short-term prognosis of patients with decompensated liver cirrhosis.