血清胱抑素C联合总胆红素对慢加急性肝衰竭患者短期预后的预测价值

摘要/Abstract

摘要： 目的探讨血清胱抑素C(CysC)联合总胆红素(TBil)对乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者短期预后的预测价值。方法入选2012年1月至2016年1月在西京消化病医院住院且资料完整的HBV-ACLF患者,统计患者入院24 h内的一般资料、各项临床检测指标、Child-Turcotte-Pugh评分(CTP评分)、终末期肝病模型评分(MELD评分),所有患者均随访90 d,根据转归分为生存组和死亡组,Logistic多因素回归分析影响患者预后的独立危险因素。结果 162例患者中死亡78例,血清CysC、TBil是影响HBV-ACLF患者生存的独立危险因素。血清CysC与血肌酐(Cr)、MELD评分呈正相关,Spearman相关系数分别为0.400、0.416,均P<0.01。联合血清CysC与TBil组成的预后模型(PM)的ROC曲线下面积(AUC)为0.833,其早期预测HBV-ACLF患者90 d死亡与否的价值高于CTP评分、MELD评分(P<0.05)。高危组(PM≥3.07)90 d生存率为23.8%,低危组(PM<3.07)为79.3%(P<0.01)。结论血清CysC联合TBil建立的预后模型是一个简单易用的评分模型,且对HBV-ACLF患者90 d病死率的预测作用优于CTP和MELD评分。

关键词: 乙型肝炎, 慢加急性肝衰竭, 胱抑素C, 总胆红素, 预后

Abstract: Objective To investigate the prognostic value of combined serum cystatin C (CysC) and total bilirubin (TBil) for patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods In the retrospective analysis, 162 patients with HBV-ACLF admitted in our hospital from January 2012 to January 2016 were enrolled. Baseline clinical information, laboratory examination results, Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease (MELD) score were collected within 24 h after admission. All patients were followed up for 90 days and divided into survival and death groups according to prognoses. Multivariate logistic regression analysis was applied to identify independent risk factors. Results Seventy-eight (48.2%) patients died during the 90-day follow-up. Serum CysC and TBil were independent predictors for mortality (P<0.01). Additionally, serum CysC was positively correlated with serum creatinine (Cr) (r=0.400, P<0.001) and MELD score (r=0.416, P<0.001), respectively. In the combination prognostic model (PM) of serum CysC and TBil, area under the receiver operating characteristic curve was 0.833, suggesting that PM had a higher predictive value than CTP and MELD score for 90-day mortality in HBV-ACLF patients. The survival rate in high risk group (PM ≥ 3.07) was 23.8%, which was markedly lower than that in low risk group (PM<3.07) (79.3%, P<0.001). Conclusion The combination prognostic model of CysC and TBil is superior to the only CTP score or MELD score in predicting 90-day mortality for HBV-ACLF patients.

Key words: Hepatitis B, Acute-on-chronic liver failure, Cystatin C, Total bilirubin, Prognosis

卢萌萌,周新民. 血清胱抑素C联合总胆红素对慢加急性肝衰竭患者短期预后的预测价值[J]. 肝脏, 2017, 22(3): 205-209.

LU Meng-meng,ZHOU Xin-min. Prognostic value of combined serum cystatin C and total bilirubin in patients with acute-on-chronic liver failure[J]. Chinese Hepatolgy, 2017, 22(3): 205-209.

参考文献

[1] Liu H,Zhang H,Wan G,et al. Neutrophil-lymphocyte ratio:a novel predictor for short-term prognosis in acute-on-chronic hepatitis B liver failure. J Viral Hepat,2014,21:499-507.
[2] Bernal W,Jalan R,Quaglia A,et al. Acute-on-chronic liver failure. Lancet,2015,386:1576-1587.
[3] Angeli P,Rodriguez E,Piano S,et al. Acute kidney injury and acute-on-chronic liver failure classifications in prognosis assessment of patients with acute decompensation of cirrhosis. Gut,2015,64:1616-1622.
[4] Shi X,Zhu P,Yan G,et al. Clinical characteristics and long-term outcome of acute kidney injury in patients with HBV-related acute-on-chronic liver failure.J Viral Hepat,2016,23: 920-929.
[5] Zang H,Liu F,Liu H,et al. Incidence,risk factors and outcomes of acute kidney injury (AKI) in patients with acute-on-chronic liver failure (ACLF) of underlying cirrhosis. Hepatol Int,2016, 10: 807-818.
[6] Ahn HS,Kim YS,Kim SG,et al. Cystatin C is a good predictor of hepatorenal syndrome and survival in patients with cirrhosis who have normal serum creatinine levels. Hepatogastroenterology,2012,59:1168-1173.
[7] 中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2012年版). 实用肝脏病杂志,2013,16:210-216.
[8] Zhang Q,Li Y,Han T,et al. Comparison of Current Diagnostic Criteria for Acute-On-Chronic Liver Failure. PLsS One,2015,10:e122158.
[9] Yang WB,Chen EQ,Bi HX,et al. Different models in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure. Ann Hepatol,2012,11:311-319.
[10] Pereira LM,Langley PG,Hayllar KM,et al. Coagulation factor V and VIII/V ratio as predictors of outcome in paracetamol induced fulminant hepatic failure:relation to other prognostic indicators. Gut,1992,33:98-102.
[11] Jalan R,Saliba F,Pavesi M,et al. Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure. J Hepatol,2014,61:1038-1047.
[12] Hsu CY,Lin HC,Huang YH,et al. Comparison of the model for end-stage liver disease (MELD),MELD-Na and MELDNa for outcome prediction in patients with acute decompensated hepatitis. Dig Liver Dis,2010,42:137-142.
[13] Karvellas CJ,Pink F,Mcphail M,et al. Bacteremia,acute physiology and chronic health evaluation II and modified end stage liver disease are independent predictors of mortality in critically ill nontransplanted patients with acute on chronic liver failure. Crit Care Med,2010,38:121-126.
[14] Vosylius S,Sipylaite J,Ivaskevicius J. Sequential organ failure assessment score as the determinant of outcome for patients with severe sepsis. Croat Med J,2004,45:715-720.
[15] Zheng MH,Shi KQ,Fan YC,et al. A model to determine 3-month mortality risk in patients with acute-on-chronic hepatitis B liver failure. Clin Gastroenterol Hepatol,2011,9:351-356.
[16] Wu SJ,Yan HD,Zheng ZX,et al. Establishment and validation of ALPH-Q score to predict mortality risk in patients with acute-on-chronic hepatitis B liver failure:a prospective cohort study. Medicine (Baltimore),2015,94:e403.
[17] Malinchoc M,Kamath PS,Gordon FD,et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology,2000,31:864-871.
[18] Qin G,Bian Z,Shen Y,et al. Logistic regression model can reduce unnecessary artificial liver support in hepatitis B virus-associated acute-on-chronic liver failure:decision curve analysis. BMC Med Inform Decis Mak,2016,16:59.
[19] He WP,Hu JH,Zhao J,et al. Comparison of four prognostic models and a new Logistic regression model to predict short-term prognosis of acute-on-chronic hepatitis B liver failure. Chin Med J (Engl),2012,125:2272-2278.
[20] 万志红,王建军,谢国明,等. 血清胱抑素C对慢加急性肝衰竭患者肾损伤的早期诊断意义. 临床肝胆病杂志,2014,30:666-669.
[21] Wan Z,Wu Y,Yi J,et al. Combining serum cystatin C with total bilirubin improves short-term mortality prediction in patients with HBV-related acute-on-chronic liver failure. PLoS One,2015,10:e116968.
[22] Gerbes AL,Gulberg V. Renal failure in cirrhosis. N Engl J Med,2010,362:79-81.
[23] Culafic D,Stulic M,Obrenovic R,et al. Role of cystatin C and renal resistive index in assessment of renal function in patients with liver cirrhosis. World J Gastroenterol,2014,20:6573-6579.
[24] Heilman RL,Mazur MJ. Cystatin C as a more sensitive indicator of diminished glomerular filtration rate. Liver Transpl,2005,11:264-266.
[25] Wan ZH,Wang JJ,You SL,et al. Cystatin C is a biomarker for predicting acute kidney injury in patients with acute-on-chronic liver failure. World J Gastroenterol,2013,19:9432-9438.