纤维蛋白原是影响HBV相关慢加急性肝衰竭近期预后的独立危险因素

肝脏 ›› 2020, Vol. 25 ›› Issue (10): 1090-1093.

纤维蛋白原是影响HBV相关慢加急性肝衰竭近期预后的独立危险因素

江丽萍, 陈阮琴, 陈明胜

350001 福州福建医科大学孟超肝胆医院肝病科

收稿日期:2020-04-04 出版日期:2020-10-31 发布日期:2020-12-18
通讯作者: 陈明胜,Email:cmscms@163.com
基金资助:
福州市感染性疾病医学中心资助项目(2018080306); 福建省临床重点专科建设项目

Fibrinogen is an independent risk factor affecting the short-term prognosis of HBV-related acute-on-chronic liver failure

JIANG Ling-ping, CHEN Ruan-qin, CHEN Ming-sheng

Department of Hepatology, Mengchao Hepatobiliary Hospital of Fujian Medical University; Fuzhou 350001

Received:2020-04-04 Online:2020-10-31 Published:2020-12-18
Contact: CHEN Mingsheng,Email:cmscms@163.com

摘要/Abstract

摘要： 目的比较乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者的血栓弹力图(TEG)及凝血指标在评估患者近期预后方面的价值。方法对福建医科大学孟超肝胆医院2017年5月至2019年1月间收治的117例HBV相关ACLF患者进行回顾性研究,收集患者TEG、凝血功能、生化、血常规等指标;比较生存组和死亡组上述指标的差异;运用多因素logistic回归分析HBV-ACLF的独立危险因素;并用ROC曲线评价独立危险因素对HBV-ACLF患者预后评估的价值。结果死亡组R值、K值、PT、INR、D-D、TBil、AST、Scr水平、HBV DNA载量均明显高于生存组〔死亡组VS生存组:R值为6.60±3.86比4.84±1.4、PT为37.13±14.35比24.60±6.67、INR为3.40(2.57~5.51)比1.84(1.46~2.21)、D-D 为5.32(3.51~9.34)比1.78(0.77~4.29)、TBil为366.20(326.95~464.85)比218.45(107.20~330.65)〕(P均<0.05),而CI值、MA值、Angle角、PTA、Fg、PLT水平均低于生存组(死亡组VS生存组:PTA为24.69±12.72比38.84±12.92、Fg为1.04±0.51比1.83±0.62、PLT为108.88±45.60比126.29±46.86)(均P<0.05);且影响HBV-ACLF患者近期预后有统计学意义的变量为TBil(OR:0.993,95%CI:0.987~0.999)及Fg(OR:14.922,95%CI:2.302~96.741);TBil及Fg对HBV-ACLF患者90天生存率评估的AUC分别为0.810(95%CI:0.733~0.886)及0.851(95%CI:0.777~0.925)。结论 Fg和TBil为HBV-ACLF患者近期预后的独立危险因素。

关键词: 血栓弹力图, 凝血指标, 纤维蛋白原, 肝功能衰竭, 预后

Abstract: Objective To compare and evaluate the value of thromboelastogram(TEG)and coagulation indexes in predicting the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF), and to analyze the independent risk factors affecting the short-term prognosis of HBV-ACLF. Methods A retrospective study was conducted on 117 patients with HBV-related ACLF treated in Mengchao Hepatobiliary Hospital of Fujian Medical University from May 2017 to January 2019. The indexes of TEG, blood coagulation, biochemistry and blood routine were collected; the differences of the above indexes between the survival group and the death group were compared; the independent risk factors of HBV-ACLF were analyzed by multivariate logistic regression; and the value of independent risk factors in evaluating the prognosis of HBV-ACLF patients was evaluated by ROC curve. Results The R value, K value, PT, INR, D-D, TBil, AST, Scr and HBV DNA load in the death group were significantly higher than those in the survival group〔death group VS survival group: R value is 6.60 ±3.86 vs 4.84 ±1.4, PT is 37.13 ±14.35 vs 24.60 ±6.67, INR is 3.40 (2.57-5.51) vs 1.84 (1.46-2.21), TBil is 5.32 (3.51-9.34) vs 1.78 (0.77-4.29), TBil is 366.20 (326.95-464.85) vs 218.45 (107.20-330.65)〕(all P<0.05), while the CI value, MA value, Angle angle, PTA, Fg and PLT levels in the death group were lower than those in the survival group(death group vs survival group: PTA is 24.69±12.72 vs 38.84±12.92、Fg is 1.04±0.51 vs 1.83±0.62、PLT is 108.88±45.60 vs 126.29±46.86)(all P<0.05). TBil (OR:0.993,95%CI:0.987~0.999) and Fg (OR:14.922,95%CI:2.302~96.741) were statistically significant variables affecting the short-term prognosis of HBV-ACLF patients. The AUC of 90-day survival rate of HBV-ACLF patients evaluated by TBil and Fg were 0.810 (95%CI:0.733~0.886) and 0.851 (95%CI:0.777~0.925). Conclusion Fg and TBil are independent risk factors for short-term prognosis in patients with HBV-ACLF, and Fg is effective in predicting the short-term prognosis of patients with ACLF.

Key words: thromboelastography, coagulation index, fibrinogen, liver failure, prognosis

江丽萍, 陈阮琴, 陈明胜. 纤维蛋白原是影响HBV相关慢加急性肝衰竭近期预后的独立危险因素[J]. 肝脏, 2020, 25(10): 1090-1093.

JIANG Ling-ping, CHEN Ruan-qin, CHEN Ming-sheng. Fibrinogen is an independent risk factor affecting the short-term prognosis of HBV-related acute-on-chronic liver failure[J]. Chinese Hepatolgy, 2020, 25(10): 1090-1093.

参考文献 15

[1]	Dhiman RK, Agrawal S, Gupta T, et al.Chronic liver failure-sequential organ failure assessment is better than the Asia-Pacific Association for the Study of Liver criteria for defining acute-on-chronic liver failure and predicting outcome. World J Gastroenterol, 2014,20:14934-14941.
[2]	Nakayama N, Uemura H, Uchida Y, et al.A multicenter pilot survey to clarify the clinical features of patients with acute-on-chronic liver failure in Japan. Hepatol Res, 2018,48:303-312.
[3]	Jalan R, Saliba F, Pavesi M, et al.Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure. J Hepatol, 2014,61:1038-1047.
[4]	肝衰竭诊治指南(2018年版). 临床肝胆病杂志, 2019:38-44.
[5]	Peck-Radosavljevic M. Review article: coagulation disorders in chronic liver disease. Aliment Pharmacol Ther, 2007,26 Suppl 1:21-28.
[6]	Amitrano L, Guardascione MA, Brancaccio V, et al.Coagulation disorders in liver disease. Semin Liver Dis, 2002,22:83-96.
[7]	卢振, 王瑜芬. 凝血指标和血小板参数在肝病进展中的变化规律. 国际检验医学杂志, 2017:921-923.
[8]	江晓燕, 甘巧蓉, 李孝楼, 等. 血栓弹力图评价乙型肝炎病毒相关慢加急性肝衰竭患者出血风险及预后价值研究. 传染病信息, 2019:54-57.
[9]	李晨. 乙型肝炎病毒相关慢加急性肝衰竭患者近期预后风险和TRAIL在该类患者发病机制中的研究. (02) ,2016.
[10]	Sørensen B, Tang M, Larsen OH, et al. The role of fibrinogen: a new paradigm in the treatment of coagulopathic bleeding. Thromb Res, 2011,128 Suppl 1:S13-16.
[11]	Sørensen B, Larsen OH, Rea CJ, et al.Fibrinogen as a hemostatic agent. Semin Thromb Hemost, 2012,38:268-273.
[12]	Cong YL, Wei YX, Zhang LW, et al.The relationship between hemostatic changes in liver cirrhosis patients with different degrees of liver lesions in reference to Child-Pugh scores. Zhonghua Gan Zang Bing Za Zhi, 2005,13:31-34.
[13]	Shao Z, Zhao Y, Feng L, et al.Association between plasma fibrinogen levels and mortality in acute-on-chronic hepatitis B liver failure. Dis Markers, 2015,2015:468596.
[14]	Wu J, Chen L, Chen Y, et al.Serum ferritin concentration predicts mortality in patients with hepatitis B virus-related acute on chronic liver failure. Arch Med Res, 2014,45:251-256.
[15]	Tsubota A, Arase Y, Suzuki Y, et al.Lamivudine monotherapy for spontaneous severe acute exacerbation of chronic hepatitis B. J Gastroenterol Hepatol, 2005,20:426-432.