单核细胞与高密度脂蛋白胆固醇比值对HBV相关慢加急性肝衰竭短期预后的预测价值

Value of monocyte to high-density lipoprotein cholesterol ratio in predicting the short-term prognosis of hepatitis B virus-related acute-on-chronic liver failure

目的探讨单核细胞与高密度脂蛋白胆固醇比值(MHR)对HBV相关慢加急性肝衰竭(HBV-ACLF)患者短期预后的预测价值。方法纳入西部战区总医院消化内科2015年1月1日—2021年12月31日住院HBV-ACLF患者131例,根据入院后90 d预后分为生存组(n=87)与死亡组(n=44)。回顾性分析患者的年龄、性别、BMI及入院后24 h内患者血常规、生化及凝血功能,并计算单核细胞与淋巴细胞比值(MLR)、MHR及MELD评分。正态分布的计量资料2组间比较使用成组t检验;非正态分布的计量资料2组间比较采用Mann-Whitney U检验;计数资料2组间比较采用χ^(2)检验。采用二元Logistic回归分析各因素与HBV-ACLF短期预后的关系,绘制受试者工作特征曲线(ROC曲线)评价MHR对于HBV-ACLF患者短期预后的预测价值;通过Kaplan-Meier法分析高MHR组与低MHR组患者短期死亡情况。结果两组患者在年龄、BMI、WBC、中性粒细胞计数、淋巴细胞计数、单核细胞计数、AFP、Na^(+)、TBil、INR、TG、MLR、MHR及MELD评分之间比较,差异均有统计学意义(P值均<0.05)。二元Logistic回归分析发现,年龄、BMI、Na^(+)、TG、MLR、MHR、MELD评分为HBV-ACLF短期预后的独立危险因素(P值均<0.05)。MHR预测HBV-ACLF患者90 d生存率的曲线下面积为0.627(95%CI:0.522~0.732,P=0.018),MHR最佳截断值为2.472,其敏感度为0.591,特异度为0.690。Kaplan-Meier生存分析发现,高MHR组(MHR≥2.472)90 d生存率明显低于对应的低MHR组(MHR<2.472)(P=0.001)。结论在排除严重心血管疾病情况下,MHR可作为HBV-ACLF短期预后的临床预测指标,需扩大样本量进一步评估其预测价值。

Objective To investigate the value of monocyte to high-density lipoprotein cholesterol ratio(MHR)in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).Methods A total of 131 patients with HBV-ACLF who were hospitalized in Department of Gastroenterology,The General Hospital of Western Theater Command,from January 1,2015 to December 31,2021 were enrolled in this study,and according to the prognosis on day 90 after admission,they were divided into survival group with 87 patients and death group with 44 patients.A retrospective analysis was performed for the data on age,sex,body mass index(BMI),and the results of blood routine test,biochemical parameters,and coagulation function within 24 hours after admission,and monocyte-to-lymphocyte ratio(MLR),MHR,and MELD score were calculated.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.The binary logistic regression analysis was used to investigate the association between each factor and the short-term prognosis of HBV-ACLF;the receiver operating characteristic(ROC)curve was plotted to analyze the value of MHR in predicting short-term prognosis of HBV-ACLF patients;the Kaplan-Meier method was used to analyze the short-term death of patients in the high MHR group and the low MHR group.Results There were significant differences between the two groups in age,body mass index(BMI),white blood cell count,neutrophil count,lymphocyte count,monocyte count,alpha-fetoprotein,Na^(+),total bilirubin,international normalized ratio,triglyceride(TG),MLR,MHR,and MELD score(all P<0.05).The binary logistic regression analysis showed that age,BMI,Na^(+),TG,MLR,MHR,and MELD score were independent risk factors for the short-term prognosis of HBV-ACLF(all P<0.05).MHR had an area under the ROC curve of 0.627(95%confidence interval:0.522-0.732,P=0.018)in predicting the 90-day survival rate of HBV-ACLF patients,with a sensitivity of 0.591 and a specificity of 0.690 at the optimal cut-off value of 2.472.The Kaplan-Meier survival analysis showed that the high MHR group(MHR≥2.472)had a significantly lower 90-day survival rate than the low MHR group(MHR<2.472)(P=0.001).Conclusion After severe cardiovascular disease is excluded,MHR can be used as a clinical predictive factor for the short-term prognosis of HBV-ACLF,and studies with a larger sample size are needed to further investigate its predictive value.