| 乙型肝炎慢加急性肝衰竭前期的临床特征及预后评分模型的建立 |
| |
| 引用本文： | 邬天舟,梁茜,李佳琪,李坦,杨玲玲,李江,辛娇娇,江静,石东燕,任可可,郝绍瑞,金林峰,叶萍,黄建荣,徐小微,高志良,段钟平,韩涛,王宇明,王宝菊,甘建和,冯婷婷,潘晨,陈永平,黄燕,谢青,蔺淑梅,陈新,辛绍杰,李兰娟,李君. 乙型肝炎慢加急性肝衰竭前期的临床特征及预后评分模型的建立[J]. 中华肝脏病杂志, 2020, 0(4): 310-318 |
| |
| 作者姓名： | 邬天舟 梁茜 李佳琪 李坦 杨玲玲 李江 辛娇娇 江静 石东燕 任可可 郝绍瑞 金林峰 叶萍 黄建荣 徐小微 高志良 段钟平 韩涛 王宇明 王宝菊 甘建和 冯婷婷 潘晨 陈永平 黄燕 谢青 蔺淑梅 陈新 辛绍杰 李兰娟 李君 |
| |
| 作者单位： | 浙江大学医学院附属第一医院传染病诊治国家重点实验室、国家感染性疾病临床医学中心;台州市中心医院（台州学院附属医院）精准医学中心;中山大学医学院附属第三医院感染科;首都医科大学附属北京佑安医院疑难肝病及人工肝中心;天津市第三中心医院肝病科;中国人民解放军陆军军医大学第一附属医院感染科;华中科技大学附属协和医院感染科;苏州大学附属第一医院感染科;福建医科大学附属传染病医院感染科;温州医科大学附属第一医院感染科;中南大学医学院附属湘雅一院感染科;上海交通大学医学院附属瑞金医院感染科;西安交通大学医学院第一附属医院感染科;浙江大学医学院药物生物技术研究所;中国人民解放军总医院第五医学中心 |
| |
| 基金项目： | 国家自然科学基金重点项目(81830073);国家科技重大专项(2017ZX10203201)。 |
| |
| 摘 要： | 目的探讨乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)前期患者的临床特征,并建立相应的预后评分模型。方法利用HBV-ACLF中国诊断标准研究(COSSH-ACLF)队列,回顾性分析725例乙型肝炎相关慢加急性肝功能障碍(HBV-ACHD)患者的临床特征,采用多因素COX回归分析90 d预后的相关独立危险因素并建立预后评分模型,并利用内部500例和外部390例HBV-ACHD患者进行验证。结果在725例HBV-ACHD患者中,男性为主(76.8%),96.8%患者有肝硬化基础,并发症以腹水(66.5%)多见,器官衰竭以凝血功能衰竭(4.1%)为主,90 d病死率为9.2%。多因素COX回归分析得出,总胆红素(TBil)、白细胞计数(WBC)、碱性磷酸酶(ALP)是HBV-ACHD患者90 d病死率的最佳预测指标,并建立评分模型COSSH-ACHDs=0.75×ln(WBC)+0.57×ln(TBil)-0.94×ln(ALP)+10,其受试者工作特征曲线下面积(auROC)显著高于终末期肝病模型(MELD)、MELD-Na、CTP及CLIF-C ADs(P<0.05),500例内部随机选择组和390例外部验证组均验证了类似结果。结论HBV-ACHD患者是一组以肝硬化失代偿为主、合并少量器官衰竭的人群,其90 d病死率为9.2%,COSSH-ACHDs具有更高的预测HBV-ACHD患者90 d预后的效能,为临床早期诊治提供循证医学依据。
|
| 关 键 词： | 乙型肝炎 慢加急性肝衰竭前期 预后评分 |
Establishment of clinical features and prognostic scoring model in early-stage hepatitis B-related acute-on-chronic liver failure |
| |
| Wu Tianzhou,Liang Xi,Li Jiaqi,Li Tan,Yang Lingling,Li Jiang,Xin Jiaojiao,Jiang Jing,Shi Dongyan,Ren Keke,Hao Shaorui,Jin Linfeng,Ye Ping,Huang Jianrong,Xu Xiaowei,Gao Zhiliang,Duan Zhongping,Han Tao,Wang Yuming,Wang Baoju,Gan Jianhe,Fen Tingting,Pan Chen,Chen Yongping,Huang Yan,Xie Qing,Lin Shumei,Chen Xin,Xin Shaojie,Li Lanjuan,Li Jun. Establishment of clinical features and prognostic scoring model in early-stage hepatitis B-related acute-on-chronic liver failure[J]. Chinese journal of hepatology, 2020, 0(4): 310-318 |
| |
| Authors: | Wu Tianzhou Liang Xi Li Jiaqi Li Tan Yang Lingling Li Jiang Xin Jiaojiao Jiang Jing Shi Dongyan Ren Keke Hao Shaorui Jin Linfeng Ye Ping Huang Jianrong Xu Xiaowei Gao Zhiliang Duan Zhongping Han Tao Wang Yuming Wang Baoju Gan Jianhe Fen Tingting Pan Chen Chen Yongping Huang Yan Xie Qing Lin Shumei Chen Xin Xin Shaojie Li Lanjuan Li Jun |
| |
| Affiliation: | (State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,Collaborative National Clinical Research Center for Infectious Diseases,The First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Precision Medicine Center,Taizhou Central Hospital,Taizhou University Medical School,Taizhou 318000,China;Department of Liver and Infectious Disease,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510000,China;Department of Liver and Infectious Diseases,Beijing YouAn Hospital,Capital Medical University,Beijing 100069,China;Department of Liver and Infectious Diseases,Tianjin Third Central Hospital,Tianjin 300170,China;Department of Liver and Infectious Disease,The First Hospital Affiliated To AMU,Chongqing 400038,China;Department of Liver and Infectious Disease,Union Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430022,China;Department of Liver and Infectious Disease,The First Affilated Hospital of Soochow University,Suzhou 215006,China;Department of Liver and Infectious Diseases,Mengchao Hepatobiliary Hospital of Fujian Medical University,Fuzhou 350005,China;Department of Liver and Infectious Diseases,The First Affilated Hospital of Wenzhou Medical University,Wenzhou 325000,China;Department of Liver and Infectious Diseases,Xiangya Hospital Central South University,Changsha 410013,China;Department of Liver and Infectious Diseases,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China;Department of Liver and Infectious Diseases,First Affilated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Institute of Pharmaceutical Biotechnology,Zhejiang University School of Medicine,Hangzhou 310058,China;Department of liver and Infectious Diseases,The Fifth Medical Center of PLA General Hospital,Beijing 100039,China) |
| |
| Abstract: | Objective To explore the clinical characteristics and establish a corresponding prognostic scoring model in patients with early-stage clinical features of hepatitis B-induced acute-on-chronic liver failure(HBV-ACLF).Methods Clinical characteristics of 725 cases with hepatitis B-related acute-on-chronic hepatic dysfunction(HBV-ACHD)were retrospectively analyzed using Chinese group on the study of severe hepatitis B(COSSH).The independent risk factors associated with 90-day prognosis to establish a prognostic scoring model was analyzed by multivariate Cox regression,and was validated by 500 internal and 390 external HBV-ACHD patients.Results Among 725 cases with HBV-ACHD,76.8%were male,96.8%had cirrhosis base,66.5%had complications of ascites,4.1%had coagulation failure in respect to organ failure,and 9.2%had 90-day mortality rate.Multivariate Cox regression analysis showed that TBil,WBC and ALP were the best predictors of 90-day mortality rate in HBV-ACHD patients.The established scoring model was COSS-HACHADs=0.75×ln(WBC)+0.57×ln(TBil)-0.94×ln(ALP)+10.The area under the receiver operating characteristic curve(AUROC)of subjects was significantly higher than MELD,MELD-Na,CTP and CLIF-C ADs(P<0.05).An analysis of 500 and 390 cases of internal random selection group and external group had similar verified results.Conclusion HBV-ACHD patients are a group of people with decompensated cirrhosis combined with small number of organ failure,and the 90-day mortality rate is 9.2%.COSSH-ACHDs have a higher predictive effect on HBV-ACHD patients'90-day prognosis,and thus provide evidence-based medicine for early clinical diagnosis and treatment. |
| |
| Keywords: | Hepatitis B Acute-on-chronic hepatic dysfunction Prognostic score |
| 本文献已被 维普 等数据库收录！ |
|
