低血红蛋白/红细胞分布宽度比值对HBV相关失代偿期肝硬化预后的评价

An evaluation on low hemoglobin/red blood cell distribution width ratio for the prognosis of HBV-related decompensate cirrhosis

目的确定血红蛋白(Hb)/红细胞分布宽度(RDW)比值对乙型肝炎病毒(HBV)相关失代偿期肝硬化(HBV-DC)患者预后评价的价值。方法选取2015年1月—2022年2月期间收治的HBV-DC患者141例,其中男116例、女25例,年龄52(46,64)岁。HBV-DC诊断符合既往标准。依据141例HBV-DC病例存活和死亡状态施行分组,比较两组的临床资料。结果141例HBV-DC患者中存活120例、死亡21例。存活组TBil、Scr、RDW、INR及MELD评分分别为36.3(18.0,99.6)μmol/L、71.0(58.7,83.2)μmol/L、15.8(14.8,17.8)%、1.3(1.2,1.6)及11.4(6.5,15.7)分,与死亡组[78.2(51.0,239.6)μmol/L、92.3(66.6,125.1)μmol/L、20.1(17.3,21.7)%、1.6(1.3,1.9)及20.2(13.1,22.5)分]相比显著降低(P<0.05);存活组患者Hb、Hb/RDW分别为108(90,122)g/L、6.6(5.2,7.8),均显著高于死亡组[95(71,110)g/L、4.9(3.9,5.8),P<0.05]。多因素logistic回归分析显示,Hb/RDW、MELD评分为HBV-DC患者死亡发生的独立危险因素(P<0.05),并据此进行ROC曲线分析显示,Hb/RDW诊断HBV-DC患者死亡发生时截断点6.0%,敏感度85.0%(102/120),特异度66.7%(14/21),AUC值0.78;MELD评分诊断截断点17.4分,敏感度66.7%(80/120),特异度85.7%(18/21),AUC值0.80。Hb/RDW联合MELD评分诊断时AUC值为0.86。以Hb/RDW=6.0%为截断点,将HBV-DC患者分为低Hb/RDW组(n=62)、高Hb/RDW组(n=79)。低Hb/RDW组Hb、RDW、INR、MELD评分及30 d病死率为85(72,96)g/L、18.4(17.0,20.8)%、1.5(1.3,1.7)、14.2(9.2,18.7)分及17例(27.4%),与高Hb/RDW组[110(108,130)g/L、15.1(17.3,21.7)%、1.3(1.2,1.5)、11.2(6.6,14.9)分及4例(5.1%)]比较差异有统计学意义(P<0.05)。结论Hb/RDW、MELD评分是HBV-DC患者死亡的独立危险因素,Hb/RDW、MELD评分联合应用可以有效预测HBV-DC患者预后情况。

Objective To determine the value of hemoglobin/red blood cell distribution(Hb/RDW)ratio in evaluating the prognosis of patients with hepatitis B virus(HBV)-related decompensate cirrhosis(HBV-DC).Methods 141 patients with HBV-DC admitted from January 2015 to February 2022 were selected,including 116 males and 25 females,with an average age of 52(46,64)years.HBV-DC was diagnosed according to the previous standard.One hundred and forty-one cases of HBV-DC were divided into a survival group and a death group according to their survival and death status.Results Of the 41 patients with HBV-DC,120 survived and 21 died.In the survival group,the scores of TBil,Scr,RDW,INR and MELD were 36.3(18.0,99.6)μmol/L,71.0(58.7,83.2)μmol/L,15.8(14.8,17.8)%,1.3(1.2,1.6)and 11.4(6.5,15.7)points,which were significantly decreased when compared with those of 78.2(51.0,239.6)μmol/L,92.3(66.6,125.1)μmol/L,20.1(17.3,21.7)%,1.6(1.3,1.9)and 20.2(13.1,22.5)points in the death group,respectively(P<0.05).Hb and Hb/RDW in the survival group were 108(90,122)g/L and 6.6(5.2,7.8),which were significantly higher than those of 95(71,110)g/L and 4.9(3.9,5.8)in the death group,respectively(P<0.05).Multivariate logistic regression analysis showed that Hb/RDW and MELD scores were independent risk factors for the deaths of HBV-DC patients(P<0.05).ROC curve analysis for the independent risk factors such as Hb/RDW and MELD score showed that the cutoff point of Hb/RDW in diagnosing the death of HBV-DC patients was 6.0%,with a sensitivity of 85.0%(102/120),a specificity of 66.7%(14/21)and the AUC value of 0.78;The cutoff point of MELD score was 17.4,with a sensitivity of 66.7%(80/120),a specificity of 85.7%(18/21),and the AUC value of 0.80.The AUC value of Hb/RDW combined with MELD score was 0.86.When setting Hb/RDW=6.0%as the cutoff point,the HBV-DC patients were divided into a low Hb/RDW group(n=62)and a high Hb/RDW group(n=79).In the low Hb/RDW group,the scores of Hb,RDW,INR,MELD and the 30-day mortality were 85(72,96)g/L,18.4(17.0,20.8)%,1.5(1.3,1.7),14.2(9.2,18.7)and 17 cases(17 cases),which were significantly different than those of 110(108,130)g/L,15.1(17.3,21.7)%,1.3(1.2,1.5),11.2(6.6,14.9)and 4 cases(5.1%)in the high Hb/RDW group,respectively(P<0.05).Conclusion Hb/RDW and MELD scores are independent risk factors for the death of HBV-DC patients.The combined application of Hb/RDW and MELD scores can effectively predict the prognosis of HBV-DC patients.