乙型肝炎相关慢加急性肝衰竭患者急性肾损伤的影响因素和高危人群分析

肝脏 ›› 2019, Vol. 24 ›› Issue (9): 997-1001.

乙型肝炎相关慢加急性肝衰竭患者急性肾损伤的影响因素和高危人群分析

张志侨, 叶一农, 何纲, 王鹏, 李静, 吴兴柳

528300 南方医科大学顺德医院感染性疾病科(张志侨,王鹏,李静);佛山市第一人民医院感染科(叶一农);广东省江门市中心医院感染科(何纲,吴兴柳)

收稿日期:2019-05-05 发布日期:2020-04-15
通讯作者: 叶一农,Email:fsyyn001@126.com
基金资助:
广东省医学科学技术研究基金项目(A2016450,B2018237)

Study of risk factors and high-risk population of acute kidney injury in patients with hepatitis B virus related acute on chronic liver failure

ZHANG Zhi-qiao¹, YE Yi-nong², HE Gang³, WANG Peng¹, LI Jing¹, WU Xing-liu³

1. Department of Infectious Diseases, Shunde Hospital of Southern Medical University, Guangdong 528300, China;
2. Department of Infectious Diseases, The First People's Hospital of Foshan, Foshan, Guangdong 528000, China;
3. Department of Infectious Diseases, The Jiangmen Central Hospital, Guangdong, 529000, China

Received:2019-05-05 Published:2020-04-15
Contact: YE Yi-nong, E-mail:fsyyn001@126.com

摘要/Abstract

摘要： 目的探讨基于分类树模型分析乙型肝炎相关慢加急性肝衰竭患者急性肾损伤的影响因素和高危人群的应用价值。方法本研究为回顾性观察性横断面研究,收集2010年1月至2018年6月在佛山市第一人民医院感染科、江门市中心医院感染科和南方医科大学顺德医院感染性疾病科住院治疗的乙型肝炎相关慢加急性肝衰竭患者的临床资料,利用分类树模型探索急性肾损伤的影响因素和高危人群。结果急性肾损伤组患者的MELD评分(31.6±9.0)和年龄(51.0±14.3)岁显著高于非急性肾损伤组患者的MELD评分(21.5±6.1)和年龄(44.1±13.0)岁,两组间差异有统计学意义(P<0.05)。多因素Logistic回归分析提示MELD评分(OR=1.209,95%CI:1.141~1.281)和年龄(OR=1.042,95%CI:1.012~1.072)可能为慢加急性肝衰竭患者发生急性肾损伤的独立影响因素。分类树模型提示慢加急性肝衰竭患者发生急性肾损伤的影响因素有MELD评分和年龄。基于MELD评分和年龄而建立的分类树模型的估计误差为0.127,提示该分类树模型的拟合效果较好。结论通过分类树模型发现慢加急性肝衰竭患者发生急性肾损伤和MELD评分、年龄关系密切,根据这2个指标建立的简单风险评估方法可用于评估慢加急性肝衰竭患者发生急性肾损的风险。

关键词: 乙型肝炎, 慢加急性肝衰竭, 急性肾损伤, 分类树, 影响因素, 高危人群

Abstract: Objective To investigate the risk factors and high-risk population of acute kidney injury (AKI) in patients with hepatitis B virus related acute on chronic liver failure (HBV-ACLF) by classification tree method, and to establish a simple method for evaluating the risk of AKI in patients with HBV-ACLF.Methods The clinical data of patients with HBV-ACLF hospitalized in the Department of Infectious Diseases from 3 hospitals including the First People's Hospital of Foshan, Jiangmen Central Hospital and Shunde Hospital of Southern Medical University from January 2010 to June 2018 were collected and analyzed. The risk factors and high-risk population of AKI were investigated by classification tree method.Results The model for end-stage liver disease (MELD) score and age in AKI group were significantly higher than those in non-AKI group (31.6±9.0 vs 21.5±6.1, 51.0±14.3 vs 44.1±13.0), with significant difference (P<0.05). Multivariate logistic regression analysis suggested that MELD score (odds ratio [OR]=1.209, 95% confidence interval [CI]: 1.141-1.281) and age (OR=1.042, 95%CI: 1.012-1.072) were independent factors of AKI in patients with HBV-ACLF. The classification tree model suggested that the factors affecting AKI in patients with HBV-ACLF include MELD score and age. The total agreement rate of the classification tree model based on MELD score and age was 0.873, indicating that the classification tree model had a better fitting effect.Conclusion AKI in patients with HBV-ACLF is related to MELD score and age. And a simple classification tree model based on MELD score and age can be used to assess the risk of AKI in patients with HBV-ACLF.

Key words: Hepatitis B, Acute on chronic liver failure, Acute kidney injury, Classification tree, Risk factor, High-risk population

张志侨, 叶一农, 何纲, 王鹏, 李静, 吴兴柳. 乙型肝炎相关慢加急性肝衰竭患者急性肾损伤的影响因素和高危人群分析[J]. 肝脏, 2019, 24(9): 997-1001.

ZHANG Zhi-qiao, YE Yi-nong, HE Gang, WANG Peng, LI Jing, WU Xing-liu. Study of risk factors and high-risk population of acute kidney injury in patients with hepatitis B virus related acute on chronic liver failure[J]. Chinese Hepatolgy, 2019, 24(9): 997-1001.

参考文献

[1] 刘晓燕,胡瑾华,王慧芬,等. 1977例急性、亚急性、慢加急性肝衰竭患者的病因与转归分析.中华肝脏病杂志,2008,16:772-775.
[2] Belcher JM, Sanyal AJ, Peixoto AJ, et al. Kidney biomarkers and differential diagnosis of patients with cirrhosis and acute kidney injury. Hepatology, 2014, 60: 622-632.
[3] Shi X, Zhu P, Yan G, et al. Clinical characteristics and long-term outcome of acute kidney injury in patients with HBV related acute on chronic liver failure. J Viral Hepat, 2016, 23: 920-929.
[4] 吴振平,钟渊斌,李小鹏,等. 乙型肝炎病毒相关慢加急性(亚急性)肝功能衰竭患者中急性肾损伤的分析. 中华传染病杂志,2016,34:713-716.
[5] 张玲芳,王介非.乙型肝炎相关慢加急性肝衰竭患者发生急性肾损伤的相关因素分析.肝脏,2015, 20:606-609.
[6] Navarro Silvera SA, Mayne ST, Gammon MD, et al. Diet and lifestyle factors and risk of subtypes of esophageal and gastric cancers: classification tree analysis. Ann Epidemiol, 2014, 24: 50-57.
[7] 赵文波,司美君,李慧群,等.分类树模型分析筛选1型糖尿病患者白蛋白尿的危险因素. 中华肾脏病杂志,2017,33: 656-662.
[8] 中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2012 年版).中华临床感染病杂志,2012, 5:321-327。
[9] Angeli P, Gines P, Wong F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the international club of ascites. Gut, 2015, 64: 531-537.
[10] Runyon BA. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology, 2013, 57: 1651-1653.
[11] EASL/AASLD. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases. J Hepatol, 2014, 61: 642-659.
[12] Bai Y, Li ZS. Guidelines for the diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding (2015, Nanchang, China). J Dig Dis, 2016, 17: 79-87.
[13] 中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016年版). 中华结核和呼吸杂志, 2016, 39: 1-27.
[14] Malinchoc M, Kamath PS, Gordon FD, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology, 2000, 31: 864-871.
[15] Chen N, Chen XH, Ding XQ, et al. Analysis of the high incidence of acute kidney injury associated with acute-on-chronic liver failure. Hepatol Int, 2018, 12: 262-268.
[16] Yuan W, Zhang YY, Zhang ZG, et al. Risk factors and outcomes of acute kidney injury in patients with hepatitis B virus-related acute-on-chronic liver failure. Am J Med Sci, 2017, 353: 452-458.
[17] Jin X, Chen YP, Yang YD, et al. Association between hepatic steatosis and entecavir treatment failure in Chinese patients with chronic hepatitis B. PLoS One, 2012, 7: e34198.
[18] Navarro Silvera SA, Mayne ST, Gammon MD, et al. Diet and lifestyle factors and risk of subtypes of esophageal and gastric cancers: classification tree analysis.Ann Epidemiol, 2014, 24: 50-57.
[19] Gandomi AH, Fridline MM, Roke DA. Decision tree approach for soil liquefaction assessnlent. Sci World J, 2013: 346285.
[20] Zang H, Liu F, Liu H, et al. Incidence, risk factors and outcomes of acute kidney injury (AKI) in patients with acute-on- chronic liver failure (ACLF) of underlying cirrhosis. Hepatol Int, 2016, 10: 807-818.