血栓弹力图最大振幅对HBV相关慢加急性肝衰竭患者短期临床结局的预测

摘要/Abstract

摘要： 目的探索血栓弹力图(TEG)最大振幅(MA)在乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)中的应用价值。方法纳入2023年1月至2024年6月收治的HBV-ACLF患者53例,同期慢性乙型肝炎患者40例、健康体检者(对照组)30名。比较三组凝血指标及TEG参数。随访90 d,将HBV-ACLF组患者分为存活组、死亡组,比较两组临床资料,利用Cox回归分析发现影响HBV-ACLF临床结局的因素,并通过绘制受试者工作特征(ROC)曲线分析上述因素对不同临床结局HBV-ACLF的预测价值。结果 HBV-ACLF组、CHB组及对照组INR、APTT、TT、FIB、R时间、K时间、α角及MA比较,差异有统计学意义(P<0.05)。随访观察90 d,HBV-ACLF组中存活、死亡病例分别为35例、18例。与存活组相比,死亡组患者PLT、α角、MA及FIB明显减少(P<0.05),R时间、K时间、INR和MELD评分显著增加(P<0.05)。单变量Cox回归分析显示,PLT、INR、FIB、K时间、MA和MELD评分是HBV-ACLF患者死亡发生的相关因素(P<0.05)。将上述因素纳入多变量Cox回归分析提示,INR、MA是HBV-ACLF患者死亡发生的独立预测因素(P<0.05),具体风险比为0.93(95%CI:0.84～0.97,P<0.05)、3.11(95%CI:1.93～5.07,P<0.05)。通过绘制ROC曲线评估MA和INR预测HBV-ACLF患者死亡发生的预测价值,MA、INR诊断AUC值分别为0.85(95%CI:0.77～0.93)、0.77(95%CI:0.74～0.80),当两者联合时,诊断AUC值为0.90(95%CI:0.82～0.97)。结论 MA作为评估HBV-ACLF患者凝血功能的动态指标,在预测短期临床结局方面展现了重要的临床价值。通过监测MA,能够更好地识别患者的出血和血栓风险,从而为个体化治疗提供依据,为临床决策提供更为全面的支持。

Abstract: Objective To explore the application value of thromboelastography (TEG) parameter, maximum amplitude (MA), in HBV-related acute-on-chronic liver failure (HBV-ACLF), and provide more evidence for optimizing the diagnosis and treatment strategy of ACLF. Methods Between January 2023 and June 2024, 53 patients with HBV-ACLF were admitted, 40 patients with chronic hepatitis B and 30 healthy people (control group) during the same period were included in the study. The coagulation indexes and TEG parameters of the three groups were compared. After a 90-day follow-up, the patients were divided into survival group and death group, and the clinical data of the two groups were compared. Cox regression analysis was used to find the factors affecting the clinical outcome of HBV-ACLF, and the prediction of the above factors on different clinical outcomes was analyzed by drawing the receiver operating characteristic (ROC) curve. Results The differences in INR, APTT, TT, FIB, R time, K time, α angle and MA among HBV-ACLF group, CHB group and control group were statistically significant (P<0.05). After a 90-day follow-up observation, there were 35 surviving and dead cases in HBV-ACLF group. Compared with the survival group, PLT, α-angle, MA and FIB in the dead group decreased significantly (P<0.05), while the scores of R time, K time, INR and MELD increased significantly (P<0.05). Univariate Cox regression analysis showed that PLT, INR, FIB, K-time, MA and MELD scores were related with the death of HBV-ACLF patients (P<0.05). The multivariate Cox regression analysis showed that INR and MA were independent predictors of the death of HBV-ACLF patients (P<0.05), with specific hazard ratios of 0.93 (95% CI: 0.84~0.97, P<0.05) and 3.11 (95% CI: 1.93~5.07, P<0.05). The value of MA and INR in predicting the death of HBV-ACLF patients was evaluated by drawing ROC curve. The diagnostic values (area under the curve, AUC) of MA and INR were 0.85 (95% CI: 0.77~0.93) and 0.77 (95% CI: 0.74~0.80), respectively. When they were combined, the diagnostic AUC value was 0.90 (95% CI: 0.82~0.97, P<0.05). Conclusion MA, as a dynamic index to evaluate the coagulation function of HBV-ACLF patients, has shown a important clinical value in predicting short-term clinical outcomes. By monitoring MA, the risk of bleeding and thrombosis in HBV-ACLF patients can be better identified, thus providing basis for individualized treatment and more comprehensive support for clinical decision-making.

Key words: HBV-related acute-on-chronic liver failure, Maximum amplitude of thromboelastogram, Cox regression analysis, Receiver operating characteristic curve

周慧敏, 张懿德, 沈琰. 血栓弹力图最大振幅对HBV相关慢加急性肝衰竭患者短期临床结局的预测[J]. 肝脏, 2025, 30(11): 1529-1533.

ZHOU Hui-min, ZHANG Yi-de, SHEN Yan. Prediction of short-term clinical outcome of HBV-related patients with acute-on-chronic liver failure by maximum amplitude of thromboelastography[J]. Chinese Hepatolgy, 2025, 30(11): 1529-1533.

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