单核细胞-淋巴细胞比率在乙型肝炎相关慢加急性肝衰竭预后评估中的价值

Value of the monocyte-to-lymphocyte ratio in the prognostic evaluation of hepatitis B-related acute-on-chronic liver failure

目的探讨单核细胞—淋巴细胞比率(MLR)在乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者生存中的预测价值。方法选取2014年10月至2017年10月收治于西部战区总医院的92例HBV-ACLF患者,回顾性收集临床检测指标并随访90d的生存情况,终点为死亡或肝移植。对比MLR在纳入90d后生存组与死亡组的差别及其与肝功能各指标的相关性,分析MLR水平对患者预后的预测价值。结果共纳入92例患者,90d生存率52%(48/92),病死率48%(44/92);生存组MLR为0.520(0.310,0.828),死亡组为0.740(0.440,1.120),死亡组MLR水平显著高于生存组(P<0.05):受试者操作特征曲线(ROC)分析提示生存组ROC曲线下面积(AUC)和95%可信区间分别为0.640(0.527~0.754)。MLR截断值为0.399时,灵敏度与特异度分别为0.864.0.396;生存分析显示高MLR组的90d生存率显著低于对应的低MLR组(P=0.011)。logistic多因素分析显示,在校正其他因素后,MLR水平是HBV-ACLF患者预后的独立影响因素。结论MLR可作为HBV-ACLF患者潜在的预后判断指标,临床价值有待随机大样本前瞻性试验来验证。

Objective To investigate the predictive value of the monocyte-to-lymphocyte ratio(MLR)for survival in patients with hepatitis B-related acute-on-chronic liver failure(HBV-ACLF).Methods 92 cases with HBV-ACLF who were admitted to the General Hospital of Western Theater Command from October 2014 to October 2017 were selected.Clinical indicators were retrospectively collected,and their survival condtion was followed up for 90 days,with the end point as death or liver transplantation.MLR levels predictive value among patients after 90 days of involvement was compared by analyzing the differences between the survival and death groups and its correlation with various indicators of liver function for prognosis.Results 92 cases were included in this study,with a 90-day survival rate of 52%(48/92),and a mortality rate of 48%(44/92).MLR for survival and death groups were 0.520(0.310,0.828)and 0.740(0.440,1.120),respectively.MLR level was significantly higher in the death than survival group(P<0.05).Receiver operating characteristie curve(ROC)analysis showed that the area under the ROC curve(AUC)and 95%confidence interval for the survival group was 0.640(0.527-0.754).The cutoff value for MLR was 0.399 at which the sensitivity and specifieity were 0.864 and 0.396,respectively.Survival analysis showed that the 90-day survival rate was significantly lower in the high MLR group than corresponding low MLR group(P=0.011).Logistic mulivariate regression analysis showed that after adjusting for other factrs,MLR level was an independent prognostic factor in patients with HBV-ACLF.Conclusions MLR can be used as a potential prognostic indicator for patients with HBV-ACLF,and is clinical value needs to be verified by large-scale prospective randomized trials.