慢性乙肝肝硬化患者肝性脑病不同分级与肝脏储备功能的相关性

Correlation between different grades of hepatic encephalopathy and liver reserve function in patients with chronic hepatitis B cirrhosis

目的 回顾性研究分析慢性乙肝肝硬化并发不同分级的肝性脑病(HE)患者的临床特点,探究影响HE患者预后的因素。方法 将380例HE患者根据临床症状进行分级,分为1~4级。分析各级HE患者的性别、年龄、实验室检查情况、终末期肝病模型(MELD)、谷草转氨酶与血小板计数比值(APRI)及白蛋白与总胆红素比值(ALBI)。采用Spearman相关性分析轻、重型HE的影响因素,并使用多因素Logistic回归法分析HE预后的影响因素,最后选用ROC曲线来评估各种独立变量对HE预后的预测价值。结果 1~4级HE患者组间性别、年龄差异均无统计学意义(均P>0.05),而血氨、MELD、APRI和ALB差异均有统计学差异(均P<0.05)。轻、重型HE患者中性粒细胞计数和淋巴细胞计数的比值(NLR)、血氨、总胆红素(TBil)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、肿瘤坏死因子(TNF-α)、MELD、APRI及ALBI差异有统计学意义(均P<0.05)。相关性分析显示,NLR、PLR、血氨、TBIL、ALT、AST及TNF-α是重型HE的独立影响因素。血氨及MELD评分与肝脏储备功能的相关性最高。NLR、血氨、 TBil、 TNF-α、高MELD评分及合并电解质紊乱均为HE预后的独立影响因素。ROC曲线分析显示,NLR的曲线下面积最大,其灵敏度最高、特异度也最大。结论 MELD、APRI和ALBI可用来评估不同分级HE患者的肝脏储备功能。在轻、重型HE中,血氨及MELD评分影响最大。在评估预后影响因素中,NLR水平可作为HE患者预后不良的危险因素。

Objective To retrospectively analyze the clinical characteristics of patients with chronic hepatitis B cirrhosis(CHBC) complicated by different grades of hepatic encephalopathy(HE), and to explore the factors affecting the prognosis of HE patients. Methods A total of 380 HE patients were graded according to clinical symptoms and divided into grades1 to 4. The differences in gender, age, laboratory tests, end-stage liver disease(MELD), aspartate aminotransferase and platelet count(APRI), ratio of albumin and total bilirubin(ALBI) of HE patients at all stages were analyzed. Spearman correlation was used to analyze the causes of mild and severe HE, and multivariate Logistic regression was used to analyze the effect on HE prognosis. ROC curve was used to evaluate the predictive value of various independent variables on HE prognosis. Results The patients with grades 1 to 4 HE had no significant differences in gender and age(all P>0.05), but in the ratio of blood ammonia, MELD, APRI and ALBI(all P<0.05). The ratio of neutrophil count to lymphocyte count(NLR), blood ammonia, total bilirubin(TBil), alanine aminotransferase(ALT), aspartate aminotransferase(AST), tumor necrosis factor(TNF-α), MELD, APRI and ALBI were statistically significant between mild and severe HE patients(all P<0.05). Correlation analysis showed that NLR, PLR, blood ammonia, TBIL, ALT, AST and TNF-α were the independent factors of severe HE. Blood ammonia and MELD score had the best correlation in evaluating liver reserve function.Multivariate Logistic regression study showed that NLR, blood ammonia, TBil, TNF-α, high MELD score and combined electrolyte disturbance were all significant factors for the prognosis of HE. ROC curve showed that the area under the curve of NLR was the best, with the highest sensitivity and specificity. Conclusion MELD, APRI and ALBI can be used to evaluate the liver reserve function of patients with different grades of HE. In mild and severe HE, blood ammonia and MELD scores had the greatest impact. In evaluating prognostic factors, NLR level can be used as a risk factor for poor prognosis in HE patients.