选择性血浆置换术前血小板水平与HBV相关慢加急性肝衰竭患者院内预后的关联

摘要/Abstract

摘要： 目的探索选择性血浆置换(SPE)术前血小板水平与乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)院内预后的关联。方法选择2017年1月至2020年12月福建医科大学孟超肝胆医院接受SPE干预的129例HBV-ACLF患者为研究对象,按SPE术前血小板水平分为三组:重度血小板减少组(A组):＜50×10⁹/L、中度血小板减少组(B组):50~100×10⁹/L及正常组(C组):≥100×10⁹/L,比较三组患者的临床特征,多因素logistic回归分析调整潜在混杂因素后发现SPE术前血小板水平与HBV-ACLF院内预后之间的独立关联。结果 129例SPE干预的HBV-ACLF患者,男112例,女17例,年龄45(38,53)岁,终末期肝脏疾病模型(MELD)评分20.86 (18.41,23.25),发生院内不良预后比例22.48%(29/129);多因素logistic回归分析并调整了潜在的混杂因素后显示,SPE术前血小板水平是HBV-ACLF院内预后的独立影响因素;术前血小板计数3分组在调整模型II中,B组和C组的OR分别为0.10(95% CI:0.01~0.78,P=0.029)和0.01(95% CI:0.00~0.13,P<0.001),未调整混杂因素与调整混杂因素后效应方向一致,在各模型中三组血小板水平的趋势性检验的P均＜0.001。结论 SPE术前血小板水平与HBV-ACLF患者院内预后风险呈负相关,血小板水平越高,发生院内不良预后的风险越低,对于SPE术前血小板水平较低者,应给予更积极的监测、评估和处理以改善其预后。

关键词: 血小板, 乙型肝炎病毒, 慢加急性肝衰竭, 选择性血浆置换

Abstract: Objective To explore the association between preoperative platelet levels of selective plasma exchange (SPE) and in-hospital prognosis in hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).Methods A total of 129 patients with HBV-ACLF who received SPE intervention in Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2017 to December 2020 were selected as the study subjects, and were divided into three groups according to the preoperative platelet levels of SPE: severe thrombocytopenia group (group A): <50×10⁹/L, moderate thrombocytopenia group (group B): 50~100×10⁹/L and normal group (group C): ≥100×10⁹/L, and the clinical characteristics of the three groups were compared. Multivariate logistic regression analysis found an independent association between preoperative platelet levels and in-hospital prognosis of HBV-ACLF after adjusting for potential confounders.Results Among the 129 patients with HBV-ACLF with SPE intervention, [gender: male/female=112/17, age: 45 (38,53) years], the end-stage liver disease model (MELD) score was 20.86 (18.41, 23.25), and the proportion of in-hospital adverse prognosis was 22.48% (29/129). Multivariate logistic regression analysis and adjustment for potential confounding factors showed that platelet level before SPE was an independent influencing factor for the in-hospital prognosis of HBV-ACLF. In the adjusted model II, the OR of group B and group C was 0.10 (95% CI: 0.01-0.78, P=0.029) and 0.01 (95% CI: 0.00-0.13, P<0.001), respectively, and the direction of effect after adjusting for confounding factors was consistent with that of the unadjusted confounding factors, and the P values of the trend test of platelet levels in the three groups were <0.001.Conclusion The preoperative platelet level of SPE was negatively correlated with the in-hospital prognostic risk of HBV-ACLF patients, and the higher the platelet level, the lower the risk of poor in-hospital prognosis. Patients with low platelet levels prior to SPE should receive more proactive monitoring, assessment and management to improve prognosis.

Key words: Platelet levels, hepatitis B virus, acute-on-chronic liver failure, selective plasma exchange, association

林建辉, 陈丽霞, 翁钘钘, 陈敏, 谢文国, 刘海钰. 选择性血浆置换术前血小板水平与HBV相关慢加急性肝衰竭患者院内预后的关联[J]. 肝脏, 2024, 29(12): 1527-1533.

LIN Jian-hui, CHEN Li-xia, WEN Xin-xin, CHEN Ming, XIE Wen-guo, LIU Hai-yu. Association between platelet levels before selective plasmapheresis and in-hospital prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure[J]. Chinese Hepatolgy, 2024, 29(12): 1527-1533.

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