慢性乙型肝炎患者肝硬化发生率及与预后的关系分析

摘要/Abstract

摘要： 目的分析慢性乙型肝炎(CHB)患者肝硬化发生率及与预后的关系。方法纳入泰州市第二人民医院2021年5月至2023年5月收治的89例CHB患者,采用回顾性队列研究方法进行分析。入院后检测总胆红素(TBil)、血肌酐(Scr)、凝血酶原标准化比值(INR)。给予抗病毒、免疫调节、抗炎、抗氧化和保肝等相关治疗措施。结合患者是否发生肝硬化将其分为发生组和未发生组,分析影响CHB患者发生肝硬化的因素,并通过ROC曲线分析相关指标对CHB患者发生肝硬化的评估价值。对患者随访1年,结合患者预后状况将其分为预后良好组和不良组(死亡),分析影响CHB患者预后不良的因素,并通过ROC曲线分析相关因素对CHB患者预后不良的评估价值。结果 89例CHB患者中,19例(21.35%)患者发生肝硬化。与未发生组相比,发生组肝功能分级为C级占比更高、病程时间更长,PLT水平更低(P<0.05)。经二元logistic回归分析,病程时间[OR=2.169(95%CI:1.349~3.489)]、肝功能分级为C级[OR=4.350(95%CI:1.456~12.993)]是CHB患者发生肝硬化的危险因素,PLT水平[OR=0.927(95%CI:0.890~0.965)]是CHB患者发生肝硬化的保护因素(P<0.05)。经ROC曲线分析,病程时间、PLT、肝功能分级为C级及联合预测CHB患者发生肝硬化的灵敏度分别为78.90%、73.70%、47.40%、89.50%;特异度分别为71.40%、67.10%、82.90%、90.00%。且病程时间、PLT、肝功能分级为C级联合预测CHB患者发生肝硬化具有较高的价值(AUC为0.899)。89例CHB患者中,有15例患者预后不良(16.85%)。预后不良组肝功能分级为C级占比、TBil、INR、Scr水平均高于良好组(P<0.05)。经二元logistic回归分析,TBil水平[OR=1.032(95%CI:1.013~1.052)]、INR水平[OR=60.167(95%CI:6.894~525.068)]、Scr水平[OR=2.032(95%CI:1.332~3.101)]、肝功能分级为C级[OR=5.905(95%CI:1.800~19.368)]是CHB患者预后不良的影响因素(P<0.05)。经ROC曲线分析,TBil、INR、Scr、肝功能分级为C级、联合预测CHB患者预后不良的灵敏度分别为73.30%、66.70%、80.00%、53.30%、93.30%;特异度分别为74.30%、77.00%、71.60%、83.80%、89.20%。且TBil、INR、Scr、肝功能分级为C级联合预测CHB患者预后不良具有较高的价值(AUC为0.894)。结论病程时间长、肝功能分级为C级、PLT是CHB患者发生肝硬化的影响因素,且TBil、INR、Scr、肝功能分级为C级是CHB患者预后不良的影响因素,早期识别和纠正可逆因素有助于延缓CHB患者肝硬化进展和改善患者预后状况。

关键词: 慢性乙型肝炎, 肝硬化, 预后

Abstract: Objective To analyze the incidence of cirrhosis and its relationship with the prognosis of patients with chronic hepatitis B (CHB). Methods This retrospective cohort study included 89 CHB patients admitted to the Second People′s Hospital of Taizhou City from May 2021 to May 2023. The levels of total bilirubin (TBil) and serum creatinine (Scr) were detected in all patients after admission by automatic biochemical analyzer. The prothrombin normalized ratio (INR) was measured by automatic coagulation analyzer. The patients were given antiviral, immunomodulatory, anti-inflammatory, antioxidant and liver protective treatment, and divided into a progression group and a non-progression group based on whether they developed into cirrhosis or not. The factors affecting the development of cirrhosis in CHB patients were analyzed and the evaluation value of ROC curve was analyzed. The patients were followed up for 1 year and divided into a good prognosis group and a poor prognosis group (death) according to the prognosis status of the patients. The factors affecting the poor prognosis of CHB patients were analyzed and their evaluation value was analyzed by ROC curve method. Results Among 89 patients with CHB, 19 patients (21.35%) developed cirrhosis. The level of PLT in the progression group was lower than that of the non-progression group (P<0.05) and the liver function of the progression group was grade C. By binary logistic regression analysis it was shown that the duration of disease (OR=2.169, 95%CI=1.349~3.489) and liver function grade of C (OR=4.350, 95%CI=1.456~12.993) were risk factors for cirrhosis in CHB patients, whereas the PLT level (OR=0.927, 95%CI=0.890~0.965) was a protective factor for cirrhosis in CHB patients (P<0.05). According to ROC curve analysis, the sensitivity of disease duration, PLT and liver function grade C to predict the cirrhosis progression in CHB patients were 78.90%, 73.70%, 47.40% and 89.50%, respectively; the specificity was 71.40%, 67.10%, 82.90% and 90.00%, respectively. Moreover, the combination of disease duration, PLT, and liver function grade C had a high value in predicting cirrhosis progression in CHB patients (AUC=0.899). Of the 89 patients with CHB, 15 had a poor prognosis (16.85%). Liver function grade C, TBil, INR and Scr levels in the poor prognosis group were higher than those in the good prognosis group (P<0.05). By Binary Logistic regression analysis, it was shown that TBil level (OR=1.032, 95%CI=1.013~1.052), INR level (OR=60.167, 95%CI=6.894~525.068), Scr level (OR=2.032, 95%CI:1.332~3.101), grade C liver function (OR=5.905, 95%CI=1.800~19.368) were the influential factors for poor prognosis in CHB patients (P<0.05). According to ROC curve analysis, the sensitivity of TBil, INR, Scr and liver function grade C to predict poor prognosis in CHB patients was 73.30%, 66.70%, 80.00%, 53.30% and 93.30%, respectively. The specificity was 74.30%, 77.00%, 71.60%, 83.80% and 89.20%, respectively. Moreover, the combination of TBil, INR, Scr and liver function grade C had a high value in predicting poor prognosis of CHB patients (AUC=0.894). Conclusion Long duration of disease, grade C liver function and PLT are the influencing factors for cirrhosis in CHB patients, and TBil, INR, Scr and liver function grade C are the influencing factors for poor prognosis in CHB patients. Early identification and correction of reversible factors are helpful to reduce the progression of cirrhosis and improve the prognosis of CHB patients.

Key words: Chronic hepatitis B, Liver cirrhosis, Prognosis

袁璇, 杨笑雨, 陈颖. 慢性乙型肝炎患者肝硬化发生率及与预后的关系分析[J]. 肝脏, 2026, 31(3): 345-350.

YUAN Xuan, YANG Xiao-yu, CHEN Ying. An analysis on the incidence and prognosis of liver cirrhotic patients with chronic hepatitis B[J]. Chinese Hepatolgy, 2026, 31(3): 345-350.

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