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| HBV相关ACLF的临床特征及不同评分对短期预后预测效能比较 |
| Comparison of clinical characteristics of HBV-related ACLF and the predictive efficacy of different scoring systems for short-term prognosis |
| 投稿时间：2025-10-18 |
| DOI：10.3969/j.issn.1000-0399.2026.08.007 |
| 中文关键词: 慢加急性肝衰竭 乙型肝炎病毒 全身免疫炎症指数 预后 |
| 英文关键词: Acute-on-chronic liver failure Hepatitis B virus Systemic immune-inflammation index Prognosis |
| 基金项目:2025年度河南省医学科技攻关联合共建项目(编号:LHGJ20250442);2022年度人工肝专项基金(编号:iGandanF-1082022-RGG057) |
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| 摘要点击次数: 104 |
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| 中文摘要: |
| 目的 探讨全身免疫炎症指数（SII）、预后营养指数（PNI）、凝血酶原时间国际标准化比值-清蛋白比值（PTAR）及常见预后评分模型（MELD、COSSH-ACLFs）在乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）患者短期（90天）预后评估中的价值，筛选影响预后的独立危险因素。方法 采用回顾性分析方法，收集2022年6月至2024年6月于河南医药大学第一附属医院感染科收治的152例HBV-ACLF患者的临床资料。根据90天生存情况分为生存组（n=85）与死亡组（n=67）。比较两组患者的人口学特征、实验室指标（白细胞、淋巴细胞、总胆红素、凝血酶原时间等）、SII、PNI、凝血功能指标（PTAR）及预后评分（MELD、COSSH-ACLFs）。采用二元logistic回归分析影响预后的独立危险因素，并通过受试者工作特征（ROC）曲线评估各指标及评分系统对90天死亡的预测效能。结果 与生存组比较，死亡组患者年龄、白细胞计数、中性粒细胞计数、总胆红素、凝血酶原时间、国际标准化比值、SII、PTAR、MELD评分及COSSH-ACLFs评分升高，而淋巴细胞计数、PNI降低，差异均有统计学意义（P均<0.05）。死亡组肝性脑病（Ⅲ～Ⅳ级）、感染、出血、肝肾综合征、休克及呼吸衰竭的发生率均高于生存组（均P<0.05）。多因素logistic回归分析显示，年龄（OR=1.058,95%CI:1.007～1.112,P=0.025）、白细胞计数（OR=3.784,95%CI:1.123～12.744,P=0.032）、凝血酶原时间（OR=1.184,95%CI:1.051～1.334,P=0.005））和休克（OR=10.576,95%CI:1.167～95.807,P=0.036）是影响90天预后的独立危险因素，而淋巴细胞计数（OR=0.021,95%CI:0.003～0.169,P<0.001）为其保护因素。ROC曲线分析显示，SII(AUC=0.88,95%CI:0.819～0.954)和COSSH-ACLFs(AUC=0.87,95%CI:0.806～0.940)对90天死亡的预测价值优于PTAR(AUC=0.60,95%CI:0.458～0.733)和PNI(AUC=0.56,95%CI:0.423～0.687)，差异有统计学意义（P均<0.05），与MELD(AUC=0.74,95%CI:0.597～0.877)预测效能相当（P>0.05）。结论 年龄、白细胞计数、PT和并发休克是影响HBV-ACLF患者90天内死亡的独立危险因素，而淋巴细胞计数为其保护因素。SII和COSSH-ACLFs评分对该类患者短期死亡风险具有较高的预测价值，优于PTAR和PNI，可作为早期评估预后的有效工具。 |
| 英文摘要: |
| Objective To investigate the value of the systemic immune-inflammation index(SII), prognostic nutritional index(PNI), prothrombin time international normalized ratio-to-albumin ratio(PTAR), and common prognostic scoring models(MELD, COSSH-ACLFs) in assessing the short-term(90-day) prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF), and to identify independent risk factors for prognosis. Methods A retrospective analysis was conducted on clinical data from 152 patients with HBV-ACLF admitted to the department of infectious diseases,The first affiliated hospitol of Henan medical univercity from June 2022 to June 2024. Patients were divided into a survival group(n=85) and a death group(n=67) based on 90-day survival status. Demographic characteristics, laboratory parameters(white blood cell count, lymphocyte count, total bilirubin, prothrombin time, etc.), inflammatory parameter(SII), nutritional index(PNI), coagulation function indicator(PTAR), and prognostic scores(MELD, COSSH-ACLFs) were compared between the two groups. Independent risk factors for prognosis were identified using binary logistic regression, and the predictive performance of each indicator and scoring system for 90-day mortality was evaluated using receiver operating characteristic(ROC) curves. Results Compared with the survival group, the death group had significantly higher values for age(53.40±13.51 vs. 48.49±11.99 years), white blood cell count(9.54±3.67×109/L vs. 5.58±3.44×109/L), neutrophil count(7.72±3.41×109/L vs. 3.61±2.85×109/L), total bilirubin(307.75 μmol/L vs. 235.60 μmol/L), prothrombin time(23.40 s vs. 21.20 s), international normalized ratio(2.00 vs. 1.80), SII(864.42 vs. 198.07), PTAR(0.07 vs. 0.06), MELD score(25.60±9.24 vs. 18.98±4.36), and COSSH-ACLFs score(7.00±1.69 vs. 5.26±0.78), while lymphocyte count [(0.90±0.47)×109/L vs.(1.29±0.63) ×109/L] and PNI [(35.23±5.39) vs.(38.56±6.09)] were significantly lower(all P<0.05). The incidences of hepatic encephalopathy(grades Ⅲ-Ⅳ), infection, bleeding, hepatorenal syndrome, shock, and respiratory failure were significantly higher in the death group than in the survival group(all P<0.05). Multivariate logistic regression analysis identified age(OR=1.058,95%CI:1.007～1.112,P=0.025), white blood cell count(OR=3.784,95%CI:1.123～12.744, P=0.032), prothrombin time(OR=1.184,95%CI:1.051～1.334, P=0.005), and shock(OR=10.576,95%CI:1.167～95.807, P=0.036) as independent risk factors for 90-day prognosis, while lymphocyte count(OR=0.021, 95%CI:0.003～0.169, P<0.001) was a protective factor. ROC curve analysis demonstrated that SII(AUC=0.88,95%CI:0.819～0.954) and COSSH-ACLFs(AUC=0.87,95%CI:0.806～0.940) had significantly better predictive value for 90-day mortality than PTAR(AUC=0.60,95%CI:0.458～0.733) and PNI(AUC=0.56,95%CI:0.423～0.687)(both P<0.05), and were comparable to MELD(AUC=0.74,95%CI:0.597～0.877)(P>0.05). Conclusion Age, white blood cell count, prothrombin time, and concurrent shock are independent risk factors for 90-day mortality in patients with HBV-ACLF, whereas lymphocyte count is a protective factor. The SII and COSSH-ACLFs score demonstrate high predictive value for short-term mortality risk in these patients, outperforming PTAR and PNI, and can serve as effective tools for early prognostic assessment. |
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