血脂指标对乙型肝炎相关慢加急性肝衰竭前期进展的预测价值

Value of blood lipid parameters in predicting the progression of HBV-related acute-on-chronic pre-liver failure

目的 分析血脂指标在慢加急性肝衰竭前期(pre-ACLF)和慢加急性肝衰竭(ACLF)组间的差异,并探讨患者进展的危险因素。方法 回顾性分析西部战区总医院2012年1月-2020年12月ACLF组(n=118)和pre-ACLF组(n=44)患者的基线年龄、白蛋白、肌酐、血常规、血脂等指标。计量资料服从正态分布的两组间比较采用成组t检验;计量资料不服从正态分布的两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ^(2)检验。通过Logistic二元回归进行多因素分析,筛选独立预测因素。使用受试者工作特征曲线(ROC曲线)比较指标的敏感度和特异度,通过约登指数计算临界值。结果 比较两组间年龄、肌酐、白蛋白、TBil、INR、ALT、AST、TG、TC、HDL、LDL、WBC和中性粒细胞计数水平的差异,发现ACLF组患者的TC[2.02(1.56~2.37) mmol/L vs 3.01(2.57~3.66)mmol/L,Z=5.411,P<0.001]、HDL[0.40(0.25~0.49)mmol/Lvs 0.62(0.47~0.75)mmol/L,Z=4.781,P<0.001]、LDL[1.52(1.22~1.84)mmol/Lvs 1.93(1.49~2.36)mmol/L,Z=3.146,P=0.002]水平显著低于pre-ACLF组,ACLF组患者的TBil[352.13(284.32~451.19)μmol/L vs 135.80(112.80~154.68)μmol/L,Z=-9.775,P<0.001]、INR[1.96(1.71~2.51)vs 1.39(1.33~1.44),Z=-9.776,P<0.001]、WBC[6.74(5.07~9.19)×10^(9)/L vs 5.04(4.13~7.09)×10^(9)/L,Z=-3.985,P<0.001]、中性粒细胞水平[4.67(3.40~7.06)×10^(9)/L vs 3.30(2.72~5.01)×10^(9)/L,Z=-3.676,P<0.001]显著高于pre-ACLF组,两组间年龄、肌酐、白蛋白、ALT、AST和TG水平无显著差异(P值均>0.05)。进一步通过Logistic回归分析发现TC(OR=0.003,95%CI:0.000~0.068)、LDL(OR=61.901,95%CI:3.354~1 142.558)、WBC(OR=3.175,95%CI:1.097~9.185)具有独立预测价值(P值均<0.05),ROC结果显示TC的AUC为0.852,LDL敏感度为0.887,TC特异度为0.840。结论 血脂指标在pre-ACLF进展到ACLF过程中下降,提示临床医师需要关注pre-ACLF阶段脂质的变化,并及时调整营养方案。

[WTHZ]Objective To investigate the difference in blood lipid parameters between acute-on-chronic pre-liver failure(pre-ACLF)and acute-on-chronic liver failure(ACLF)and the risk factors for disease progression.[WTHZ]Methods A retrospective analysis was performed for the related data of 118 patients with ACLF(ACLF group)and 44 patients with pre-ACLF(pre-ACLF group)who were treated in The General Hospital of Western Theater Command from January 2012 to December 2020,including baseline age,albumin,creatinine,routine blood test results,and blood lipids.The independent samples t-test was used for comparison between normally distributed continuous data;and the Mann-Whitney U test was used for comparison between non-normally distributed continuous data;the chi-square test was used for comparison of categorical data between groups.A binary logistic regression analysis was used for multivariate analysis to identify independent predictive factors.The receiver operating characteristic(ROC)curve was used to compare the sensitivity and specificity of related indicators,and Youden index was used to calculate cut-off values.[WTHZ]Results Compared with the pre-ACLF group,the ACLF group had significantly lower levels of total cholesterol(TC)[2.02(1.56-2.37)mmol/L vs 3.01(2.57-3.66)mmol/L,Z=5.411,P<0.001],high-density lipoprotein[0.40(0.25-0.49)mmol/L vs 0.62(0.47-0.75)mmol/L,Z=4.781,P<0.001],and low-density lipoprotein(LDL)[1.52(1.22-1.84)mmol/L vs 1.93(1.49-2.36)mmol/L,Z=3.146,P=0.002][JP3]and significantly higher levels of total bilirubin[352.13(284.32-451.19)μmol/L vs 135.80(112.80-154.68)μmol/L,Z=-9.775,P<0.001],international normalized ratio[1.96(1.71-2.51)vs 1.39(1.33-1.44),Z=-9.776,P<0.001],white blood cell count(WBC)[6.74(5.07-9.19)×10^(9)/L vs 5.04(4.13-7.09)×10^(9)/L,Z=-3.985,P<0.001],and neutrophils[4.67(3.40-7.06)×10^(9)/L vs 3.30(2.72-5.01)×10^(9)/L,Z=-3.676,P<0.001],while there were no significant differences between the two groups in age,creatinine,albumin,alanine aminotransferase,aspartate aminotransferase,and triglyceride(all P>0.05).The logistic regression analysis showed that TC(odds ratio[OR]=0.003,95%confidence interval[CI]:0.000-0.068,P<0.05),LDL(OR=61.901,95%CI:3.354-1142.558,P<0.05),and WBC(OR=3.175,95%CI:1.097-9.185,P<0.05)had an independent predictive value,and the ROC analysis showed that the area under the ROC curve of TC was 0.852,the sensitivity of LDL was 0.887,and TC had the best specificity of TC was 0.840.[WTHZ]Conclusion There are reductions in blood lipid parameters in the progression from pre-ACLF to ACLF,suggesting that clinicians should pay attention to the changes in lipids in the pre-ACLF stage and adjust the nutritional regimen in a timely manner.