基于红细胞分布宽度和中性粒细胞/淋巴细胞比值建立慢加急性乙型肝炎肝衰竭患者短期预后预测模型价值研究

doi:10.3969/j.issn.1672-5069.2020.05.020

摘要/Abstract

摘要： 目的基于红细胞分布宽度(RDW)、中性粒细胞/淋巴细胞比值(NLR)建立乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者短期预后预测模型,即RNM。方法回顾性分析HBV-ACLF患者102例,随访患者90 d内生存情况。采用单因素和多因素分析,筛选出对预后有影响的因素,构建短期预后预测模型,即RNM。绘制受试者工作特征曲线(ROC),计算ROC曲线下面积(AUC),评价各指标预测预后的价值。结果本组90 d生存48例,死亡54例(52.9%);单因素分析显示,死亡组并发感染、RDW、WBC、NEU、NLR、TBIL、INR、Cr和MELD评分显著高于生存组(P<0.05),而淋巴细胞(LY)、ALB、Na⁺和PTA显著低于生存组(P <0.05);多因素分析显示,RDW(OR=1.410,95%CI,1.149～1.730)、NLR(OR=1.155,95%CI,1.001～1.333)和MELD评分(OR=1.128,95%CI,1.001～1.271)为影响患者死亡的独立危险因素;ROC曲线分析得出,RDW(AUC=0.826)、NLR(AUC=0.819)、MELD评分(AUC=0.791)和RNM模型(AUC=0.888)具有预测肝衰竭预后的应用价值,其中RNM模型的预测价值最优。结论我们基于RDW和NLR建立的RNM模型预测CHB-ACLF患者90 d预后有良好的预测效能。

关键词: 慢加急性肝衰竭, 红细胞分布宽度-中性粒细胞/淋巴细胞比值-终末期肝病模型, 预后 , ,

Abstract: Objective The aim of this study was to investigate the value of red blood cell distribution width (RDW) and neutrophil to lymphocyte ratio (NLR) model (RNM) for a short-term prognosis of patients with hepatitis B virus-induced acute-on-chronic liver failure (HBV-ACLF). Method A retrospective analysis was performed on 102 patients with HBV-ACLF, and the patients were followed up for 90 days. Univariate and multivariate analysis were applied to evaluate the risk factors influencing the prognosis. A short-term prognostic model, RNM was established. The receiver operating characteristic curve (ROC) was drawn and the area under the ROC curve(AUC) was compared to evaluate the predictive value of every parameter on prognosis of death. Result Out of our series, 48 survived, and 54 (52.9%) died at 90 day treatment; the univariate analysis showed that the infection, RDW, white blood cell(WBC), neutrophil(NEU), NLR, total bilirubin (TBIL), international standardization ratio(INR), creatinine(Cr), and MELD scores in the dead group were significantly higher than in the survival group (P <0.05), while the lymphocyte(LY) counts, albumin (ALB), sodium (NA⁺), prothrombin time activity (PTA) were significantly lower than in the survival group(P<0.05); multivariate analysis showed that RDW(OR=1.410, 95% CI, 1.149 to 1.730), NLR(OR=1.155, 95% CI, 1.001 to 1.333) and MELD scores(OR=1.128, 95% CI, 1.001 to 1.271) were the independent risk factors for poor prognosis; the ROC curve analysis showed that RDW(AUC=0.826), NLR(AUC=0.818), MELD scores(AUC=0.791), and RNM model(AUC=0.888) all had predictive value for the prognosis of patients with liver failure, and the RNM model had the best predictive value. Conclusion A short-term prognosis model for patients with CHB-ACLF based on RDW and NLR, namely, RNM, has a good predictive value for 90-day prognosis, which needs further investigation.

Key words: Acute-on-chronic liver failure, Red blood cell distribution width-neutrophil/lymphocyte ratio model, Prognosis

王培, 张青, 李颍, 颜学兵, 丁芹. 基于红细胞分布宽度和中性粒细胞/淋巴细胞比值建立慢加急性乙型肝炎肝衰竭患者短期预后预测模型价值研究[J]. 实用肝脏病杂志, 2020, 23(5): 682-686.

Wang Pei, Zhang Qing, Li Ying, et al.. Usefulness of red blood cell distribution width and neutrophil to lymphocyte ratio model for a short-term prognosis of patients with hepatitis B virus-induced acute-on-chronic liver failure[J]. Journal of Practical Hepatology, 2020, 23(5): 682-686.

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