HBV相关慢加急性肝衰竭患者低血糖的危险因素及与临床转归的关系

摘要/Abstract

摘要： 目的了解HBV相关慢加急性肝衰竭(HBV-ACLF)患者的空腹血糖特点及低血糖发生率,分析低血糖的危险因素及与临床转归的关系,为临床早期识别和治疗提供参考。方法回顾性分析2016年1月—2021年12月就诊于海军军医大学第一附属医院感染科的308例HBV-ACLF患者的临床资料,根据空腹血糖情况分为低血糖组和非低血糖组,采用单因素与Logistics回归分析评估低血糖发生的危险因素。结果 HBV-ACLF患者低血糖发生率为33.1%。低血糖组与非低血糖组的性别、总胆红素、γ-谷氨酰转肽酶、白细胞计数、中性粒细胞计数、凝血酶原时间、国际标准化比值、MELD评分、MELD分级及是否合并2型糖尿病、是否合并腹水在统计学上存在差异(P<0.05),进一步Logistics回归分析显示尤其女性、基线总胆红素、白细胞和中性粒细胞计数高、合并腹水是HBV-ACLF患者低血糖的危险因素,合并2型糖尿病是保护因素。ROC曲线结果AUC=0.7910(P<0.01, 95%CI: 0.7394～0.8425)。临床结局为好转组192例(62.3%),移植及死亡组116例(37.7%),低血糖与临床最终不良预后相关(χ²=8.379, P=0.004),空腹血糖每降低1 mmol/L,肝衰竭患者不良预后风险增加19.9%(OR=1.199, 95%CI: 1.055～1.362, P=0.005)。结论 HBV-ACLF患者低血糖发生率较高且与死亡率相关,女性、基线总胆红素、白细胞和中性粒细胞计数高、合并腹水的患者风险较高,临床医生应早期识别并及时处理。

关键词: 慢加急性肝衰竭, 乙型肝炎病毒, 低血糖, 危险因素, 预后

Abstract: Objective To investigate the clinical characteristics of fasting glucose levels and the incidence of hypoglycemia in patients with hepatitis B virus(HBV)-related acute-on-chronic liver failure (ACLF), and to analyze the risk factors of hypoglycemia and its association with clinical outcomes, providing valuable insights for early clinical recognition and intervention. Methods Clinical data from 308 patients with HBV-related ACLF, admitted to the Department of Infectious Diseases at the First Affiliated Hospital of Naval Medical university between January 2016 to December 2021, were retrospectively analyzed. Patients were categorized into hypoglycemic and non-hypoglycemic groups based on fasting glucose levels. Risk factors for hypoglycemia were assessed using univariate and logistic regression analyses. Results The incidence of hypoglycemia in patients with HBV-related ACLF was 33.1%. Significant differences were observed between the hypoglycemic and non-hypoglycemic groups in gender, total bilirubin, γ- gl utamyltranspeptidase, white blood cell count, neutrophil count, prothrombin time, international normalized ratio, MELD score, MELD grade, presence of type 2 diabetes and ascites (P<0.05). Logistic regression analysis identified female gender, high baseline total bilirubin, elevated white blood cell and neutrophil counts, and the presence of ascites as risk factors for hypoglycemia, while type 2 diabetes was a protective factor. The ROC curve analysis yielded an AUC of 0.7910 (P＜0.01, 95%CI: 0.7394～0.8425). Clinical outcomes included 192 cases (62.3%) in the improvement group and 116 cases (37.7%) in the transplantation and death group. Hypoglycemia was associated with poor clinical outcome (χ²=8.379, P=0.004), For every 1mmol/L decrease in blood glucose, the risk of poor prognosis increased by 19.9% (OR=1.199, 95%CI: 1.055-1.362, P=0.005). Conclusion The incidence of hypoglycemia is elevated in patients with HBV-related ACLF and is linked to increased mortality. Women and those with ascites, high baseline total bilirubin, elevated white blood cells and neutrophil counts are at greater risk. Early identifcation and management of these high-risk patients are crucial for improving outcomes.

Key words: Acute-on-chronic liver failure, Hepatitis B virus, Hypoglycemia, Risk factor, Prognosis

董旭, 廖威, 许明晓, 葛玲玲, 陈怡, 李成忠. HBV相关慢加急性肝衰竭患者低血糖的危险因素及与临床转归的关系[J]. 肝脏, 2024, 29(9): 1117-1122.

DONG Xu, LIAO Wei, XU Ming-xiao, GE Ling-ling, CHEN Yi, LI Cheng-zhong. Risk factors for hypoglycemia in hepatitis B-related acute-on-chronic liver failure and its impact on clinical outcomes[J]. Chinese Hepatolgy, 2024, 29(9): 1117-1122.

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