预后营养指数结合免疫球蛋白、血糖及甲胎蛋白对HBV相关慢加急性肝衰竭患者治疗后预后不良的预测价值

Prognostic nutritional index combined with immunoglobulin,fasting blood glucose level and serum alpha-fetoprotein in predicting poor prognosis in patients with HBV associated chronic acute liver failure after treatment

目的分析预后营养指数(PNI)结合免疫球蛋白、空腹血糖(FPG)及血清甲胎蛋白(AFP)对HBV相关慢加急性肝衰竭(HBV-ACLF)患者治疗后预后不良的预测价值。方法纳入青岛市市立医院2020年10月至2023年10月收治的220例HBV-ACLF患者,按照治疗后预后情况,将患者分别纳入预后良好组(n=118)、预后不良组(n=102),并根据预后不良患者中是否死亡分为生存组(n=68)和死亡组(n=34)。比较不同组别患者入院时的PNI、免疫球蛋白(IgG、IgM、IgA)、FPG、AFP指标,采用Logistic多因素回归分析和受试者工作特征曲线计算上述指标预测HBV-ACLF患者治疗后预后不良的价值。结果220例患者中,发生预后不良102例(46.36%),其中死亡34例(15.45%)。预后良好组患者年龄、免疫球蛋白IgG、IgA、IgM、AFP、PNI血糖高于预后不良组,FPG低于预后不良组。对预后不良组内死亡组和生存组比较,死亡组年龄、免疫球蛋白IgG、IgA、IgM、AFP、PNI血糖高于生存组,FPG低于生存组(P<0.05)。Logistic多因素回归分析显示,肝性脑病Ⅲ、Ⅳ期、免疫球蛋白IgG≥17 g/L、IgA≥3.8 g/L、IgM≥2.5 g/L、FPG<6.2 mmol/L、AFP≥80 mmol/L、PNI≥35均为影响HBV-ACLF患者近中期预后不良的危险因素(P<0.05)。联合肝性脑病Ⅲ、Ⅳ期、IgG、IgA、IgM、PNI、FPG、AFP预测患者预后不良的AUC为0.856,灵敏度、特异性为85.89%、87.69%(P<0.05)。结论HBV-ACLF患者预后与患者PNI、IgG、IgM、IgA、FPG、AFP均存在密切关联,联合监测各因素有助于为预后预测提供更可靠参考。

Objective To analyze the prognostic nutritional index(PNI)combined with immunoglobulin,fasting blood glucose(FPG)and serum alpha-fetoprotein(AFP)in predicting poor prognosis of patients with HBV associated chronic acute liver failure(HBV-ACLF)after treatment.Methods A total of 220 patients with HBV-ACLF admitted to Qingdao Municipal Hospital from October 2020 to October 2023 were included.According to the prognosis after treatment,the patients were respectively included in the good prognosis group(n=118)and the poor prognosis group(n=102),and patients with poor prognosis were divided into survival group(n=68)and death group(n=34)according to whether they died or not.The indexes of PNI,immunoglobulin(IgG,IgM,IgA),FPG and AFP were compared among patients in different groups at admission.Logistic multivariate regression analysis and receiver operating characteristic curve(ROC)were used to calculate the value of these indexes in predicting the poor prognosis of patients with HBV-ACLF after treatment.Results Among 220 patients,102 patients had poor prognosis(46.36%),and 34 patients died(15.45%).Age,immunoglobulin IgG,IgA,IgM,AFP PNI and blood glucose of patients in the good prognosis group were higher than those in the poor prognosis group,and FPG was lower than that in the poor prognosis group.Comparison between the death group and the survival group in the poor prognosis group was made,age,immunoglobulin IgG,IgA,IgM,AFP,PNI and blood glucose in the death group were higher than those in the survival group,and FPG was lower than that in the survival group(P<0.05).Logistic multivariate regression analysis showed that StageⅢandⅣof hepatic encephalopathy,immunoglobulin IgG≥17 g/L,IgA≥3.8 g/L,IgM≥2.5 g/L,FPG<6.2 mmol/L,AFP≥80 mmol/L and PNI≥35 were all risk factors for poor prognosis in patients with HBV-ACLF(P<0.05).Combined with hepatic encephalopathyⅢandⅣ,IgG,IgA,IgM,PNI,FPG and AFP,the AUC of patients with poor prognosis was 0.856,and the sensitivity and specificity were 85.89%and 87.69%(P<0.05).Conclusion The prognosis of patients with HBV-ACLF is closely correlated with PNI,IgG,IgM,IgA,FPG and AFP,and the combined monitoring of these factors is helpful to provide a more reliable reference for prognosis prediction.