重症化慢性乙型肝炎患者发展为ACLF的影响因素及预测模型构建

Influencing factors of acute exacerbation chronic hepatitis B progressing to ACLF and the construction of prediction model

目的分析重症化慢性乙型肝炎(AE-CHB)患者发展为慢加急性肝衰竭(ACLF)的影响因素,并建立预测模型。方法以南通大学附属医院2018年8月-2019年12月108例AE-CHB患者为重症组,并以同期轻症乙型肝炎病毒(HBV)感染患者69例为轻症组,分析导致AE-CHB发生的影响因素,并分析其对AE-CHB发生的预测价值。根据入院4周内ACLF发生情况将研究组患者分为ACLF患者及非ACLF患者,归纳AE-CHB患者发展为ACLF的影响因素,建立预测模型,并分析该预测模型对AE-CHB患者发展为ACLF的预测价值。结果病程、4因子的纤维化指数(FIB-4)是导致AE-CHB发生的影响因素,白蛋白(ALB)、血小板(PLT)是保护因素(P<0.05);病程、TBIL、FIB-4是导致AE-CHB患者发展为ACLF的影响因素,ALB为保护因素(P<0.05);AE-CHB患者发展为ACLF的预测模型为P=1/[1+^(e(0.633*X)病程+0.601*XTBIL+0.652*XFIB-4-0.539*XALB+0.334))],该预测模型预测AE-CHB患者发展为ACLF的AUC为0.896,SE值为0.037,95%CI为0.823~0.969。结论病程长及FIB-4、ALB、PLT是导致AE-CHB发生的影响因素,病程及TBIL、FIB-4、ALB是导致AE-CHB患者发展为ACLF的影响因素,且本研究所建立的预测模型对AE-CHB患者发展为ACLF具有较高的预测价值。

OBJECTIVE To analyze the influencing factors of acute exacerbation chronic hepatitis B(AE-CHB)developing acute on chronic liver failure(ACLF),and to establish a predictive model.METHODS A total of 108 patients with AE-CHB in the Affiliated Hospital of Nantong University from Aug.2018 to Dec.2019 were selected as the severe group,and 69 patients with mild hepatitis B virus(HBV)infection during the same period were selected as mild group.The influencing factors leading to the occurrence of AE-CHB and their predictive value for the occurrence of AE-CHB were analyzed.According to presence or absence of ACLF within 4 weeks of admission,the patients in study group were divided into ACLF group and non-ACLF group.The influencing factors of AE-CHB developing ACLF were summarized.The prediction model was constructed,and the predictive value of the predictive model for the development of ACLF in patients with AE-CHB was analyzed.RESULTS The disease course and fibrosis index of four factors(FIB-4)were influencing factors leading to the occurrence of AE-CHB,while albumin(ALB)and platelet(PLT)were protective factors(P<0.05).The disease course,TBIL and FIB-4 were influencing factors for the development of ACLF in patients with AE-CHB,while ALB was a protective factor(P<0.05).The prediction model for AE-CHB patients developing ACLF was as follow:P=1/[1+e^((0.633*X)disease course+0.601*X TBIL+0.652*X FIB-4-0.539*X ALB+0.334)].The AUC value of this prediction model for the prediction of ACLF occurrence in AE-CHB patients were 0.896,with SE of 0.037 and 95%CI of 0.823-0.969.CONCLUSION The long disease course,FIB-4,ALB and PLT were the influencing factors that lead to the occurrence of AE-CHB.The disease course,TBIL,FIB-4 and ALB were the influencing factors that lead to the development of ACLF in patients with AE-CHB.And the prediction model established in this study was of high predictive value for AE-CHB developing ACLF.