直接胆红素与总胆红素比值表达对慢性乙型肝炎患者慢加急性肝衰竭发生的评估价值

Value of Ratio Expression of Direct Bilirubin to Total Bilirubin in Evaluating the Occurrence of Chronic and Acute Liver Failure in Patients with Chronic Hepatitis B

目的探讨直接胆红素(DBIL)与总胆红素(TBIL)比值对慢性乙型肝炎患者发生慢加急性肝衰竭的评估价值,以期为临床防治慢加急性肝衰竭提供理论指导。方法采用回顾性研究方法,收集2019年1月至2023年1月商丘市中心医院40例慢性乙型肝炎并发慢加急性肝衰竭患者临床资料作为发生组,另收集同期25例慢性乙型肝炎患者临床资料作为未发生组,收集并比较两组患者的一般资料及DBIL/TBIL水平,采用多因素logistic回归性分析检验影响慢性乙型肝炎患者并发慢加急性肝衰竭的影响因素;绘制受试者工作特征(ROC)曲线分析DBIL/TBIL对慢性乙型肝炎患者并发慢加急性衰竭的评估价值。结果两组患者在中性粒细胞与淋巴细胞比值(NLR)、DBIL、TBIL、国际标准化比值(INR)以及DBIL/TBIL方面比较,差异有统计学意义(P<0.05)。经logistic回归性分析显示DBIL、TBIL、INR以及DBIL/TBIL是影响慢性乙型肝炎患者并发慢加急性肝衰竭的影响因素(P<0.05)。再绘制ROC曲线显示DBIL、DBIL/TBIL对慢性乙型肝炎患者并发慢加急性肝衰竭具有中等评估价值,TBIL的评估价值较低,其中以DBIL/TBIL的曲线下面积最大。结论DBIL/TBIL对慢性乙型肝炎患者并发慢加急性肝衰竭具有中等评估价值。

Objective To explore the evaluation value of the ratio of direct bilirubin(DBIL)to total bilirubin(TBIL)in the occurrence of chronic hepatitis B patients with chronic liver failure,in order to provide theoretical guidance for the clinical prevention and treatment of chronic liver failure.Methods A retrospective study was conducted to collect clinical data of 40 patients with chronic hepatitis B complicated with chronic and acute liver failure in Center Hospital of Shangqiu from January 2019 to January 2023 as the occurrence group,and 25 patients with chronic hepatitis B during the same period as the non occurrence group.General data and DBIL/TBIL levels were collected and compared between the two groups.Multivariate logistic regression analysis was used to test the influencing factors of chronic and acute liver failure in patients with chronic hepatitis B.A receiver operating curve(ROC)was drawn to analyze the evaluation value of DBIL/TBIL in patients with chronic hepatitis B complicated with chronic and acute failure.Results There were statistical significant differences between the two groups of patients in terms of neutrophil to lymphocyte ratio(NLR),DBIL,TBIL,international standardized ratio(INR)and DBIL/TBIL(P<0.05).Logistic regression analysis showed that DBIL,TBIL,INR and DBIL/TBIL were the influencing factors for chronic hepatitis B patients complicated with chronic and acute liver failure(P<0.05).ROC curve showed that DBIL and DBIL/TBIL had moderate evaluation value for patients with chronic hepatitis B complicated with chronic and acute liver failure,and the evaluation value of TBIL was low.The area under the curve of DBIL/TBIL was the largest.Conclusion DBIL/TBIL has moderate evaluation value for patients with chronic hepatitis B complicated with chronic and acute liver failure.