高密度脂蛋白胆固醇预测肝硬化患者预后研究

摘要/Abstract

摘要： 目的探讨高密度脂蛋白胆固醇(HDL-C)水平在非胆汁淤积性肝硬化患者预后中的预测作用。方法选取2017年1月至2020年12月至苏州大学附属第一医院就诊的肝硬化患者,收集患者入院第一天的血常规、生物化学指标、血凝常规等检查结果,并计算MELD评分、MELD-Na评分及ALBI评分,比较存活组与死亡组患者的上述指标。采用受试者操作特征曲线下面积评估HDL-C及不同评分判断肝硬化患者预后的能力。结果共纳入684例肝硬化患者,其中在院期间死亡94例,存活590例。HDL-C水平在死亡组为0.3(0.1,0.7)mmol/L,低于存活组的0.9(0.6,1.2)mmol/L,差异有统计学意义(U=12 869.0, P<0.01)。多因素logistic回归分析提示,年龄、白细胞计数、肌酐水平的提高及HDL-C水平的下降是肝硬化预后不良的危险因素(P<0.05)。HDL-C水平、MELD评分、MELD-Na评分及ALBI评分预测肝硬化死亡的AUROC分别为0.768(95%CI:0.768~0.819)、0.751(95%CI:0.691~0.810)、0.747(95%CI:0.686~0.807)、0.715(95%CI:0.659~0.770);HDL-C联合MELD评分的AUROC为0.803(95%CI:0.753~0.852),灵敏度和特异度分别为74.5%和74.2%。结论 HDL-C是肝硬化患者预后的强有力的预测因子,采用HDL-C联合MELD评分的预测能力高于单一指标。

关键词: 高密度脂蛋白胆固醇, 肝硬化, MELD评分, MELD-Na评分, ALBI评分

Abstract: Objective To investigate the predictive value of high density lipoprotein cholesterol (HDL-C) for the prognosis of patients with non-cholestatic cirrhosis. Methods 684 patients with liver cirrhosis who met the inclusion criteria in the first affiliated hospital of Soochow University from January 2017 to December 2020 were enrolled in this study. The results of blood routine, biochemical routine, coagulation routine tests and other related auxiliary examination on the first day of admission were collected. the Model for end-stage liver disease (MELD) score, MELD-Na score and Integration of albumin-bilirubin (ALBI) score were calculated and the performance of HDL-C and other scores to predict the prognosis of patients with cirrhosis were compared. Results Within the 684 patients with liver cirrhosis, 94 patients died and 590 survived during hospitalization. The level of HDL-C in death group was 0.3 (0.1-0.7) mmol/L, which is significantly lower than that in non-death group 0.9 (0.6-1.2) mmol /L (U=12 869.0, P<0.001). Multivariate logistic regression analysis showed that an increased age, white blood cell count, and creatinine level and the decreased HDL-C level were risk factors for poor prognosis of liver cirrhosis (P<0.05). The receiver operating characteristic curves (AUROC) of HDL-C level, MELD score, MELD-Na score and ALBI score were 0.768 (95 % CI: 0.768-0.819), 0.751 ( 95 % CI: 0.691-0.810), 0.747 ( 95 % CI: 0.686-0.807) and 0.715 (95 % CI: 0.659-0.770), respectively. The AUROC of HDL-C combined with MELD score was 0.803 (95% CI: 0.753-0.852), and the sensitivity and specificity were 74.5% and 74.2%, respectively. Conclusion HDL-C is a powerful predictor for the prognosis of patients with cirrhosis and the predictive ability of HDL-C combined with MELD score was significantly higher than that of single index.

Key words: High density lipoprotein cholesterol, Liver cirrhosis, MELD score, MELD-Na score, ALBI score, prognosis

虞晨燕, 高静雯, 殷民月, 吴爱荣, 朱锦舟, 刘晓琳. 高密度脂蛋白胆固醇预测肝硬化患者预后研究[J]. 肝脏, 2021, 26(7): 727-731.

YU Chen-yan, GAO Jing-wen, YIN Min-yue, WU Ai-rong, ZHU Jin-zhou, LIU Xiao-lin. A study of using high-density lipoprotein cholesterol to predict the prognosis of patients with liver cirrhosis[J]. Chinese Hepatolgy, 2021, 26(7): 727-731.

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