补体C3在HBV相关慢加急性肝衰竭患者预后评估中的价值

Prognostic value of complement C3 in patients with HBV-related acute-on-chronic liver failure

目的探讨乙型病毒性肝炎相关慢加急性肝衰竭(HBV-ACLF)患者血清补体C3水平变化及其在评估HBV-ACLF患者预后中的价值。方法回顾性分析2019年5月至2020年12月在中山大学附属第三医院诊治的138例HBV-ACLF患者临床资料。本研究已通过医学伦理委员会审批。其中男115例,女23例;年龄19~75岁,中位年龄46岁。检测血WBC、中性粒细胞与淋巴细胞比值(NLR)、TB、Scr、Na、补体C3、凝血酶原活动度(PTA)、终末期肝病模型(MELD)评分等指标,根据患者住院期间和出院后3个月内的生存情况,将患者分为生存组和死亡组。两组指标变化比较采用t检验或秩和检验,患者预后影响因素分析采用多因素Logistic回归分析。采用Logistic回归构建预测模型,其诊断效率分析采用ROC曲线。结果138例患者死亡率19.6%(27/138),其中男25例,女2例;生存组平均年龄为(45±12)岁,死亡组(50±12)岁。生存组WBC、NLR、TB、PTA、补体C3、MELD评分分别为7(4)×10^(9)/L、3.3(3.1)、308(156)μmol/L、31%(12%)、0.40(0.18)g/L、(27±4)分,死亡组相应为8(3)×10^(9)/L、5.3(7.6)、421(272)μmol/L、23%(12%)、0.36(0.23)g/L、(31±4)分,差异有统计学意义(Z=-2.311,-2.904,-3.438,-3.075,-1.742;t=-5.167;P<0.05)。多因素分析显示,年龄、TB、PTA、补体C3是HBV-ACLF患者预后的独立影响因素(OR=1.054,1.009,0.940,0.017;P<0.05)。构建预测模型:Logit(P)=-3.913-0.053×Age-0.009×TB+0.062×PTA+4.053×C3。ROC曲线分析显示,基于补体C3模型的AUC为0.833,MELD评分的AUC为0.795,差异无统计学意义(Z=0.682,P>0.05)。结论补体C3水平为HBV-ACLF预后的独立影响因素,基于补体C3预测模型对评估HBV-ACLF患者的预后、指导临床治疗有重要作用。

Objective To investigate the changes and prognostic values of serum complement C3 levels in patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).Methods Clinical data of 138 patients with HBV-ACLF admitted to the Third Affiliated Hospital of Sun Yat-sen University from May 2019 to December 2020 were retrospectively analyzed.The medical ethical committee approval was received.Among them,115 patients were male and 23 female,aged from 19 to 75 years,with a median age of 46 years.White blood cell(WBC),neutrophil-lymphocyte ratio(NLR),total bilirubin(TB),serum creatinine(Scr),Na,complement C3,prothrombin time activity(PTA)and model for end-stage liver disease(MELD)score were detected.All patients were divided into the survival and death groups according to the survival status during hospital stay and within 3 months after discharge.The changes of multiple indexes between two groups were compared by using t test or rank-sum test.The influencing factors of clinical prognosis were identified by multivariate Logistic regression analysis.Prediction model was established by Logistic regression.The diagnostic efficiency was assessed by the receiver operating characteristic(ROC)curve.Results The mortality rate of 138 patients was 19.6%(27/138),including 25 male and 2 female.The average age in the survival group was(45±12)years,and(50±12)years in the death group.The levels of WBC,NLR,TB,PTA,complement C3 and MELD score in the survival group were 7(4)×10^(9)/L,3.3(3.1),308(156)μmol/L,31%(12%),0.40(0.18)g/L,27±4,and 8(3)×10^(9)/L,5.3(7.6),421(272)μmol/L,23%(12%),0.36(0.23)g/L,31±4 in the death group,and significant differences were observed(Z=-2.311,-2.904,-3.438,-3.075,-1.742;t=-5.167;P<0.05).Multivariate analysis showed that age,TB,PTA and complement C3 were the independent prognostic factors of HBV-ACLF patients(OR=1.054,1.009,0.940,0.017;P<0.05).The prediction model was established according to the equation:Logit(P)=-3.913-0.053×Age-0.009×TB+0.062×PTA+4.053×C3.ROC curve analysis indicated that the area under ROC curve(AUC)of complement C3-based model was 0.833,and the AUC of MELD score was 0.795,and no significant difference was observed(Z=0.682,P>0.05).Conclusions The level of complement C3 is an independent prognostic factor for patients with HBV-ACLF.The complement C3-based prediction model plays a critical role in evaluating clinical prognosis and guiding clinical treatment for HBV-ACLF patients.