AARC-ACLF评分联合NLR对HBV相关慢加急性肝衰竭短期预后的评估价值

摘要/Abstract

摘要： 目的探究亚太肝脏研究协会ACLF(AARC-ACLF)评分联合中性粒细胞与淋巴细胞比值(NLR)对HBV相关慢加急性肝衰竭(ACLF)短期预后的预测价值。方法选择94例HBV相关ACLF患者作为研究对象,于入组24 h内检测NLR,计算AARC-ACLF评分。根据临床疗效及生存情况,分为转归良好组及不佳组。分析HBV相关ACLF患者病情转归的影响因素。评估AARC-ACLF评分和血清NLR水平对HBV相关ACLF预后的预测效能。结果 94例受试者中,转归良好58例,转归不佳36例。转归不佳组凝血酶原时间(PT)、总胆红素(TBil)、白细胞(WBC)、NLR及AARC-ACLF评分分别为(26.68±6.91)s、(330.2±126.4)μmol/L、(6.67±2.06)×10⁹/L、6.45±2.76、(10.14±1.29)分,转归良好组为(20.32±4.20)s、(180.1±83.7)μmol/L、(5.06±1.97)×10⁹/L、2.85±1.67、(8.03±1.09)分,差异有统计学意义(P<0.05)。NLR及AARC-ACLF评分偏高均为HBV相关ACLF患者病情转归不佳的影响因素(P<0.05);血清NLR、AARC-ACLF评分、NLR联合AARC-ACLF评分预测HBV相关ACLF患者预后的AUC分别为0.878、0.892、0.943。结论 HBV相关ACLF患者的血清NLR及AARC-ACLF评分均较高,对该病的短期预后具有一定的临床预测价值,且两者联合预测效能更高。

关键词: 亚太肝脏研究协会ACLF研究组评分, 中性粒细胞与淋巴细胞比值, 乙型肝炎相关慢加急性肝衰竭, 预后

Abstract: Objective To investigate the predictive value of the ACLF Research Group (AARC-ACLF) score combined with the neutrophil-to-lymphocyte ratio (NLR) in assessing the short-term prognosis of hepatitis B (HBV)-related chronic acute liver failure (ACLF). Methods A total of 94 patients diagnosed with HBV-related ACLF were included in this study. Upon admission, the NLR was assessed, and the AARC-ACLF score was calculated within 24 hours. Based on clinical efficacy and survival outcomes, patients were divided into a favorable prognosis group and an unfavorable prognosis group for further analysis of factors influencing disease progression in HBV-related ACLF. The predictive capacity of the AARC-ACLF score and serum NLR level on the prognosis of HBV-related ACLF was assessed. Results Among the 94 participants, 58 showed a favorable prognosis, while 36 exhibited an unfavorable prognosis. In the unfavorable prognosis group, the prothrombin time (PT), total bilirubin (TBIL), white blood cell count (WBC), NLR, and AARC-ACLF score were significantly higher [(26.68±6.91) s, (330.2±126.4) μmol/L, (6.67±2.06) ×10⁹/L, (6.45±2.76), and (10.14±1.29) points, respectively] compared to those in the favorable prognosis group [(20.32±4.20) s, (180.1±83.7) μmol/L, (5.06±1.97) ×10⁹/L, (2.85±1.67), and (8.03±1.09) points; P<0.05]. Elevated NLR and AARC-ACLF scores were identified as significant indicators of poor prognosis among HBV-related ACLF patients (P<0.05). The AUC values for predicting prognosis using serum NLR level, AARC-ACLF score, and the combination of NLR with AARC-ACLF score in HBV-related ACLF patients were 0.878, 0.892, and 0.943, respectively. Conclusion Higher serum NLR levels and AARC-ACLF scores in HBV-related ACLF patients suggest their potential as valuable clinical predictors for short-term prognosis. Combining both factors can enhance the predictive power significantly.

Key words: ACLF research group score of the Asia-Pacific association for liver research, Neutrophil to lymphocyte ratio, Chronic hepatitis B-related acute liver failure, Prognosis

韩肇丹, 许军, 李芃芃, 赵卫娟. AARC-ACLF评分联合NLR对HBV相关慢加急性肝衰竭短期预后的评估价值[J]. 肝脏, 2024, 29(5): 538-541.

HAN Zhao-dan, XU Jun, LI Peng-peng, ZHAO Wei-juan. Predictive value of AARC-ACLF score combined with NLR in the short-term prognosis of chronic hepatitis B-related acute liver failure[J]. Chinese Hepatolgy, 2024, 29(5): 538-541.

/ 推荐

参考文献

[1] 杨颜榕,徐曼曼,陈煜. 肝硬化慢加急性肝衰竭的发病诱因及管理[J]. 解放军医学杂志,2023,48(1):7-12.
[2] 涂颖,李雪,陈美娟,等. 血小板计数及相关评分模型对HBV相关慢加急性肝衰竭预后的预测价值[J]. 临床肝胆病杂志,2023,39(6):1308-1312.
[3] 汤玉会,张潇潇,张思雨,等. 乙型肝炎病毒相关慢加急性肝衰竭危险因素及其新型生存预测模型研究[J]. 中华肝脏病杂志,2023,31(1):84-89.
[4] 刘慧敏,毛青. 乙型肝炎病毒再激活致慢加急性肝衰竭研究进展[J]. 中华实验和临床病毒学杂志,2019,33(1):108-112.
[5] 李朋,李君. 慢加急性肝衰竭肝移植的获益评估及供肝分配新策略[J]. 中华肝脏病杂志,2023,31(6):569-573.
[6] 韩涛,刘国旺. 重视慢加急性肝衰竭患者肝移植治疗时机的选择与全程管理[J]. 中华肝脏病杂志,2023,31(6):561-563.
[7] 徐曼曼,武羽,李珊珊,等. 不同预后评分在慢加急性肝衰竭肝移植决策中的应用[J]. 中华肝脏病杂志,2023,31(6):574-581.
[8] Sarin S K, Choudhury A, Sharma M K, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update[J]. Hepatol Int,2019,13(4):353-390.
[9] 占伟丽,吴贺文,牛垚飞,等. 外周血NLR、PCT联合MELD评分在HBV ACLF继发感染中的临床价值[J]. 热带医学杂志,2020,20(2):233-236,前插2.
[10] 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(2018年版)[J]. 临床肝胆病杂志,2019,35(1):38-44.
[11] 李会,苏海滨,王永刚,等. 乳酸对慢加急性肝衰竭合并感染患者预后的临床预测价值分析[J]. 中华肝脏病杂志,2023,31(3):300-306.
[12] 薛红,张莉,陈伟杰,等. 肝体积联合血小板在评估慢加急性肝衰竭预后中的应用[J]. 实用医学杂志,2023,39(10):1247-1252.
[13] 乔杰,安薪宇,胡灵溪,等. 血清人β防御素-1水平评估慢加急性肝衰竭患者短期预后的临床研究[J]. 中华肝脏病杂志,2023,31(4):415-421.
[14] 刘铁峰,许澍妮,吴姗姗. 血清p62及LC3-Ⅱ联合检测对HBV-ACLF患者近期预后的价值[J]. 肝脏,2020,25(6):582-584,594.
[15] 刘积庆,于国英,杨生森,等. 多种预后评分系统预测慢加急性肝衰竭并发真菌感染患者短期预后价值分析[J]. 实用肝脏病杂志,2021,24(6):851-854.
[16] 毛雨婷,柯比努尔·吐尔逊,潘金良,等. 不同评分对慢加急性肝衰竭患者预后判断的应用价值比较[J]. 国际流行病学传染病学杂志,2023,50(1):19-24.
[17] 张文佳,赵丽娟,吴基洲. MELD、AARC、COSSH评分系统对乙型肝炎相关慢加急性肝衰竭90天预后的评估价值[J]. 临床肝胆病杂志,2020,36(4):813-817.
[18] 章颖,明芳,徐立新,等. ALBI、NLR、FIB-4、MELD评分对血浆置换治疗慢加急性肝衰竭患者短期预后的预测价值[J]. 胃肠病学,2020,25(8):462-466.
[19] 刘林,王玲,汤善宏. 单核细胞与高密度脂蛋白胆固醇比值对HBV相关慢加急性肝衰竭短期预后的预测价值[J]. 临床肝胆病杂志,2023,39(8):1841-1847.
[20] 黄洁婕,蓝婧,姚朝光,等. 基于贝叶斯网络模型分析乙型肝炎合并非酒精性脂肪肝患者中乙型肝炎病毒滴度与慢加急性肝衰竭发生的关系[J]. 中国感染与化疗杂志,2023,23(2):173-180.