乙肝肝硬化后慢加急性肝衰竭病人发生急性肾脏疾病的影响因素

Influencing factors of AKD in patients with ACLF on the basis of hepatitis B cirrhosis

目的探讨肝硬化基础上,急性肾脏疾病(acute kidney disease,AKD)在乙肝并慢加急性肝衰竭(HBV-acute-on-chronic liver failure,HBV-ACLF)病人中发生情况及其发生的危险因素。方法筛选并纳入2020年1月至2021年12月就诊于兰州大学第一医院的乙肝肝硬化后ACLF住院病人,收集初次入院时的临床资料,包括病人基本资料、有无部分肝硬化并发症及实验室指标,计算病人入院时及出院后3个月内的预估肾小球滤过率(estimated glomerular filtration rate,e-GFR)数值,分析肝硬化基础上,HBV-ACLF病人发生AKD的危险因素,并评估高危因素对HBV-ACLF病人并发AKD的区分价值。结果肝硬化基础上,AKD在HBV-ACLF病人中发生率为29.51%(36/122)。Logistic回归结果提示,高CRP[比值比(odds ratio,OR)=1.034,95%CI:1.015~1.054]及高MELD评分(OR=1.098,95%CI:1.027~1.174)是HBVACLF病人发生AKD的独立危险因素。CRP及MELD评分区分HBV-ACLF病人发生AKD的最佳阈值分别为55.55 mg/L及25.00分,其中,CRP敏感度较高。结论肝硬化基础上,高CRP及高MELD评分可能是HBV-ACLF病人发生AKD的关键影响因素,能够辅助临床早期预测HBV-ACLF病人是否发生AKD,以便早期干预,改善病人预后。

Objective To investigate the occurrence of acute kidney disease(AKD)in patients with HBV-acute-on-chronic liver failure(HBV-ACLF)based on liver cirrhosis,and to analyze the risk factors of its occurrence.Methods Screened and included inpatients with ACLF after hepatitis B cirrhosis who were treated at the First Hospital of Lanzhou University from January 2020 to December 2021,and collected the clinical data at the time of initial admission,including the basic information of the patients,the presence or absence of some complications of liver cirrhosis and experiments.The estimated glomerular filtration rate(e-GFR)values were calculated at the time of admission and within 3 months after discharge,and the risk factors of AKD in HBV-ACLF patients based on liver cirrhosis were analyzed.The value of high risk factors in the differentiation of HBV-ACLF patients with AKD was evaluated.Results On the basis of liver cirrhosis,the incidence of AKD in HBV-ACLF patients was 29.51%(36/122).Logistic regression results showed that high CRP[odds ratio(OR)=1.034,95%CI:1.015~1.054]and high MELD score(OR=1.098,95%CI:1.027~1.174)were independent risk factors for AKD in HBV-ACLF patients.The optimal thresholds of CRP and MELD scores for distinguishing AKD in HBV-ACLF patients were 55.55 mg/L and 25.00 points respectively,and CRP was more sensitive.Conclusion On the basis of liver cirrhosis,high CRP and MELD scores might be the key influencing factors of AKD in patients with HBV-ACLF,which could assist in early clinical prediction of AKD in patients with HBV-ACLF,so as to facilitate early intervention and improve the prognosis of patients.