摘要
目的比较再代偿患者与持续失代偿患者的基线数据特征,探讨基线数据中影响失代偿期乙型肝炎肝硬化(HBV-DeCi)患者实现再代偿的因素,分析血脂水平对其预后的影响。方法选取2018年6月-2023年10月徐州医科大学附属医院首次收治的295例HBV-DeCi患者,根据预后情况分为再代偿组(n=135)和持续失代偿组(n=160)。收集患者的临床资料,实验室指标[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、凝血酶原时间(PT)、国际标准化比值(INR)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、血清白蛋白(ALB)、总胆红素(TBIL)水平],并计算终末期肝病模型(MELD)评分,采用logistic回归分析患者预后的独立因素,建立联合指标的预测模型。结果再代偿组TC、TG、HDL-C水平显著高于持续失代偿组,差异均有统计学意义(Z=-3.117、-2.081、-6.502,P均<0.05)。在相关性分析中,TC、HDL-C、LDL-C与PT、INR、ALT、AST、TBIL、MELD评分成负相关(r均<0,P均<0.05),TG与ALT、AST及TBIL成正相关(r均>0,P均<0.05)。HDL-C对HBV-DeCi患者实现再代偿的预测性能最佳,AUC为0.720。多因素logistic回归分析显示,TG(OR=1.877,P<0.05)、HDL-C(OR=3.294,P<0.05)是影响再代偿的独立预测因素。联合指标预测模型预测再代偿的ROC曲线下面积(AUC)为0.747(敏感度0.889,特异度0.506,P<0.001),在独立指标中,HDL-C表现出较好的预测能力,其AUC为0.720(敏感度0.852,特异度0.512,P<0.001),优于传统MELD评分,AUC为0.573(敏感度0.852,特异度0.306,P=0.032)。结论HDL-C是HBV-DeCi患者预后的独立预测因素,提示在临床工作中,管理血脂水平可能成为改善此类患者预后的潜在治疗策略。
Objective To compare the baseline data characteristics between recurrent decompensation patients and persistently decompensated patients,and explore the factors affecting the achievement of re-compensation in patients with decompensated hepatitis B cirrhosis;based on baseline data to analyze the impact of lipid levels on their prognosis.Methods A total of 295 HBV-DeCi patients admitted to the Xuzhou Medical University Affiliated Hospital between June 2018 and October 2023 were included in this study.Patients were categorized into a recompensation group(n=135)and a persistent decompensation group(n=160)based on prognosis.Clinical data were collected,including laboratory parameters[total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),prothrombin time(PT),international normalized ratio(INR),alanine aminotransferase(ALT),aspartate aminotransferase(AST),serum albumin(ALB),total bilirubin(TBIL)].A model for end-stage liver disease(MELD)score was calculated for each patient.Logistic regression analysis was used to identify independent prognostic factors,and a combined predictive model was established.Results The levels of TC,TG and HDL-C were significantly higher in the re-compensated group than in the persistently decompensated group(Z=-3.117,−2.081,−6.502;all P<0.05);in correlation analysis,TC,HDL-C and LDL-C were negatively correlated with PT,INR,ALT,AST,TBIL,and MELD scores;and TG was positively correlated with ALT,AST,and TBIL scores(all P<0.05).HDL-C had the best predictive performance for the HBV-DeCi patients and achieved the best predictive performance of recompensation,with an AUC of 0.720,and TC,TG and LDL-C had poor predictive performance,with AUC of<0.7.Multifactorial logistic regression analysis showed that TG and HDL-C were independent predictive factors affecting recompensation(all P<0.05).The area under the ROC curve(AUC)of the joint index prediction model for predicting recompensation was O.747(sensitivity 0.889,specificity 0.506,P<0.001),and among the independent indexes,HDL-C showed better predictive ability with an AUC of 0.720(sensitivity 0.852,specificity 0.512,P<0.001),which was superior to the traditional MELD score with an AUC of only 0.573(sensitivity 0.852,specificity 0.306,P=0.032).Conclusion HDL-C was an independent prognostic factor for HBV-DeCi patients,suggesting that managing lipid levels might be a potential therapeutic strategy to improve the prognosis of these patients in clinical practice.
作者
吴少连
席德扬
单晴晴
林朝晖
汪莉萍
WU Shaolian;XI Deyang;SHAN Qingqing;LIN Zhaohui;WANG Liping(Department of Infectious Diseases,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China)
出处
《热带医学杂志》
2026年第1期74-78,92,F0004,共7页
Journal of Tropical Medicine
基金
江苏省研究生科研与实践创新项目(KYCX24_3067)。
关键词
乙型肝炎
肝硬化
失代偿期
血脂
Hepatitis B
Liver cirrhosis
Decompensated
Lipids
