低血红蛋白/红细胞分布宽度比值对HBV相关失代偿期肝硬化预后的评价

摘要/Abstract

摘要： 目的确定血红蛋白(Hb)/红细胞分布宽度(RDW)比值对乙型肝炎病毒(HBV)相关失代偿期肝硬化(HBV-DC)患者预后评价的价值。方法选取2015年1月—2022年2月期间收治的HBV-DC患者141例,其中男116例、女25例,年龄52(46, 64)岁。HBV-DC诊断符合既往标准。依据141例HBV-DC病例存活和死亡状态施行分组,比较两组的临床资料。结果 141例HBV-DC患者中存活120例、死亡21例。存活组TBil、Scr、RDW、INR及MELD评分分别为36.3(18.0, 99.6)μmol/L、71.0(58.7, 83.2)μmol/L、15.8(14.8, 17.8)%、1.3(1.2, 1.6)及11.4(6.5, 15.7)分,与死亡组[78.2(51.0, 239.6)μmol/L、92.3(66.6, 125.1)μmol/L、20.1(17.3, 21.7)%、1.6(1.3, 1.9)及20.2(13.1, 22.5)分]相比显著降低(P<0.05);存活组患者Hb、Hb/RDW分别为108(90, 122)g/L、6.6(5.2, 7.8),均显著高于死亡组[95(71, 110)g/L、4.9(3.9, 5.8), P<0.05]。多因素logistic回归分析显示,Hb/RDW、MELD评分为HBV-DC患者死亡发生的独立危险因素(P<0.05),并据此进行ROC曲线分析显示,Hb/RDW诊断HBV-DC患者死亡发生时截断点6.0%,敏感度85.0%(102/120),特异度66.7%(14/21),AUC值0.78;MELD评分诊断截断点17.4分,敏感度66.7%(80/120),特异度85.7%(18/21),AUC值0.80。Hb/RDW联合MELD评分诊断时AUC值为0.86。以Hb/RDW=6.0%为截断点,将HBV-DC患者分为低Hb/RDW组(n=62)、高Hb/RDW组(n=79)。低Hb/RDW组Hb、RDW、INR、MELD评分及30 d病死率为85(72, 96)g/L、18.4(17.0, 20.8)%、1.5(1.3, 1.7)、14.2(9.2, 18.7)分及17例(27.4%),与高Hb/RDW组[110(108, 130)g/L、15.1(17.3, 21.7)%、1.3(1.2, 1.5)、11.2(6.6, 14.9)分及4例(5.1%)]比较差异有统计学意义(P<0.05)。结论 Hb/RDW、MELD评分是HBV-DC患者死亡的独立危险因素,Hb/RDW、MELD评分联合应用可以有效预测HBV-DC患者预后情况。

关键词: 乙型肝炎病毒, 失代偿期肝硬化, 血红蛋白, 红细胞分布宽度, 受试者工作特征曲线

Abstract: Objective To determine the value of hemoglobin/red blood cell distribution (Hb/ RDW) ratio in evaluating the prognosis of patients with hepatitis B virus (HBV)-related decompensate cirrhosis (HBV-DC). Methods 141 patients with HBV-DC admitted from January 2015 to February 2022 were selected, including 116 males and 25 females, with an average age of 52 (46, 64) years. HBV-DC was diagnosed according to the previous standard. One hundred and forty-one cases of HBV-DC were divided into a survival group and a death group according to their survival and death status. Results Of the 41 patients with HBV-DC, 120 survived and 21 died. In the survival group, the scores of TBil, Scr, RDW, INR and MELD were 36.3 (18.0, 99.6) μmol/L, 71.0 (58.7, 83.2) μmol/L, 15.8 (14.8, 17.8)%, 1.3 (1.2, 1.6) and 11.4(6.5, 15.7) points, which were significantly decreased when compared with those of 78.2 (51.0, 239.6) μmol/L, 92.3 (66.6, 125.1) μmol/L, 20.1 (17.3, 21.7)%, 1.6 (1.3, 1.9) and 20.2 (13.1, 22.5) points in the death group, respectively (P<0.05). Hb and Hb/RDW in the survival group were 108 (90, 122) g/L and 6.6 (5.2, 7.8), which were significantly higher than those of 95 (71, 110) g/L and 4.9 (3.9, 5.8) in the death group, respectively (P<0.05). Multivariate logistic regression analysis showed that Hb/RDW and MELD scores were independent risk factors for the deaths of HBV-DC patients (P<0.05). ROC curve analysis for the independent risk factors such as Hb/RDW and MELD score showed that the cutoff point of Hb/RDW in diagnosing the death of HBV-DC patients was 6.0%, with a sensitivity of 85.0% (102/120), a specificity of 66.7% (14/21) and the AUC value of 0.78; The cutoff point of MELD score was 17.4, with a sensitivity of 66.7% (80/120), a specificity of 85.7% (18/21), and the AUC value of 0.80. The AUC value of Hb/RDW combined with MELD score was 0.86. When setting Hb/RDW=6.0% as the cutoff point, the HBV-DC patients were divided into a low Hb/RDW group (n=62) and a high Hb/RDW group (n=79). In the low Hb/RDW group, the scores of Hb, RDW, INR, MELD and the 30-day mortality were 85 (72, 96) g/L, 18.4 (17.0, 20.8)%, 1.5 (1.3, 1.7), 14.2 (9.2, 18.7) and 17 cases (17 cases), which were significantly different than those of 110 (108, 130) g/L, 15.1 (17.3, 21.7)%, 1.3 (1.2,1.5), 11.2 (6.6, 14.9) and 4 cases (5.1%) in the high Hb/RDW group, respectively (P<0.05). Conclusion Hb/RDW and MELD scores are independent risk factors for the death of HBV-DC patients. The combined application of Hb/RDW and MELD scores can effectively predict the prognosis of HBV-DC patients.

Key words: Hepatitis B virus, Decompensated cirrhosis, Hemoglobin, Red blood cell distribution width, Receiver operating characteristic curve

高政聪, 雷作汉, 郭舜琴. 低血红蛋白/红细胞分布宽度比值对HBV相关失代偿期肝硬化预后的评价[J]. 肝脏, 2022, 27(9): 1004-1007.

GAO Zheng-cong, LEI Zuo-han, GUO Shun-qin. An evaluation on low hemoglobin/red blood cell distribution width ratio for the prognosis of HBV-related decompensate cirrhosis[J]. Chinese Hepatolgy, 2022, 27(9): 1004-1007.

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