Yan Yan, Lyu Chunyan, Zhou Xueshi, Zhou Meifang, Mao Richeng, Davgadorj Chantsalmaa, Zhang Ying, Lu Zhonghua
Laboratory for Infection and Immunity, the Fifth People's Hospital of Wuxi, Wuxi 214016, Jiangsu, China.
Clinical Laboratory Center, the Fifth People's Hospital of Wuxi, Wuxi 214016, Jiangsu, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2022 Feb;34(2):172-177. doi: 10.3760/cma.j.cn121430-20210705-01006.
To assess the predictors of outcomes for different subtypes of liver failure, and the effectiveness of artificial liver support systems in the treatment of liver failure.
The clinical data of 112 patients with hepatitis B virus (HBV)- and non-HBV-related liver failure admitted to the intensive care unit (ICU) of the Fifth People's Hospital of Wuxi were collected from January to December 2020. The relevant etiologies of acute, subacute, acute-on-chronic, subacute-on-chronic, chronic subtype liver failure were analyzed. The efficacies of artificial liver support systems in the treatment of various subtypes of liver failure were also compared. The correlation of various indicators was analyzed by Spearman correlation analysis, the risk factors affecting the prognosis of patients with liver failure were analyzed by multivariate Logistic regression equation, and receiver operator characteristic curve (ROC curve) of subjects was plotted to evaluate the predictive value of each risk factor for the prognosis of patients with liver failure.
Among the 112 liver failure patients, 63 were caused by hepatitis B and 49 were caused by non-hepatitis B. The liver failure caused by hepatitis B was 6 times higher than for men than for women, which was higher than that of non-HBV liver failure group (1.33 times). Antithrombin III (AT III) and total bilirubin (TBil) levels of subacute liver failure were higher than those of pre-liver failure in the HBV liver failure group [AT III: (59.33±14.57)% vs. (35.66±20.72)%, TBil (μmol/L): 399.21±112.94 vs. 206.08±126.96, both P < 0.05]. The levels of AT III in patients with pre-liver failure and chronic liver failure in the non-HBV liver failure group were significantly higher than those with acute liver failure [(58.33±15.28)%, (44.00±19.10)% vs. (31.33±7.57)%, both P < 0.05], patients with acute liver failure had significantly lower level of TBil than pre-liver failure (μmol/L: 107.83±49.73 vs. 286.20±128.92, P < 0.05), the TBil levels in patients with subacute and acute-on-chronic liver failure were also significantly higher than that in pre-liver failure group (μmol/L: 417.27±118.60, 373.00±187.00 vs. 286.20±128.92, both P < 0.05). Patients with subacute liver failure, subacute-on-chronic liver failure and chronic liver failure in the non-HBV failure group were significantly longer than those in acute liver failure (days: 36.00±8.31, 27.52±11.71, 27.72±22.71 vs. 11.00±1.41, all P < 0.05). There was no statistically significant difference in the case fatality rate of using the artificial liver support system between the HBV failure group and the non-HBV failure group (55.6% vs. 50.0%, P < 0.05), the levels of AT III in the two groups of surviving patients were significantly higher than that of the dead [HBV liver failure group: (36.20±6.26)% vs. (27.33±8.87)%, non-HBV liver failure group: (41.06±4.16)% vs. (28.71±12.35)%, both P < 0.01]. Correlation analysis showed that there was a clear positive correlation between AT III and TBil in the dead patients of HBV liver failure group and the survival and death patients of non-HBV liver failure group (r values were 0.069, 0.341, 0.064, and P values were 0.723, 1.196 and 0.761, respectively); there was a significant inverse correlation between AT III and TBil in the HBV liver failure group (r = -0.105, P = 0.745). Multivariate Logistic regression analysis showed that AT III was an independent risk factor affecting the prognosis of patients with non-HBV liver failure [odd ratio (OR) = 1.023, 95% confidence interval (95%CI) was -0.001 to 0.001, P = 0.007]. TBil was an independent risk factor affecting prognosis of patients with HBV liver failure (OR = 1.005, 95%CI was -0.002 to -7.543, P = 0.033). The analysis of ROC curve showed that AT III had a predictive value for the prognosis of patients with non-HBV liver failure, the area under the ROC curve (AUC) = 0.747, the 95%CI was 0.592-0.902, P = 0.009. When the optimal truncation value was 39.5%, its sensitivity and specificity were 83.33% and 56.25%, respectively.
Artificial liver support system treatment of liver failure was difficult to effectively reduce the mortality of patients with end-stage liver failure. In addition to AT III, TBil also could be used as an indicator to assess liver compensatency and predict prognosis in liver failure patients.
评估不同亚型肝衰竭的预后预测因素，以及人工肝支持系统治疗肝衰竭的有效性。
收集2020年1月至12月无锡市第五人民医院重症监护病房（ICU）收治的112例乙型肝炎病毒（HBV）相关和非HBV相关肝衰竭患者的临床资料。分析急性、亚急性、慢加急性、亚急性慢加急性、慢性亚型肝衰竭的相关病因。比较人工肝支持系统治疗各种亚型肝衰竭的疗效。采用Spearman相关分析分析各项指标的相关性，采用多因素Logistic回归方程分析影响肝衰竭患者预后的危险因素，并绘制受试者工作特征曲线（ROC曲线）评估各危险因素对肝衰竭患者预后的预测价值。
112例肝衰竭患者中，63例由乙型肝炎引起，49例由非乙型肝炎引起。乙型肝炎所致肝衰竭男性发病率是女性的6倍，高于非HBV肝衰竭组（1.33倍）。HBV肝衰竭组亚急性肝衰竭患者的抗凝血酶III（AT III）和总胆红素（TBil）水平高于肝衰竭前期患者[AT III：（59.33±14.57）% vs.（35.66±20.72）%，TBil（μmol/L）：399.21±112.94 vs. 206.08±126.96，均P<0.05]。非HBV肝衰竭组肝衰竭前期和慢性肝衰竭患者的AT III水平显著高于急性肝衰竭患者[（58.33±15.28）%，（44.00±19.10）% vs.（31.33±7.57）%，均P<0.05]，急性肝衰竭患者的TBil水平显著低于肝衰竭前期（μmol/L：107.83±49.73 vs. 286.20±128.92，P<0.05），亚急性和慢加急性肝衰竭患者的TBil水平也显著高于肝衰竭前期组（μmol/L：417.27±118.60，373.00±187.00 vs. 286.20±128.92，均P<0.05）。非HBV衰竭组亚急性肝衰竭、亚急性慢加急性肝衰竭和慢性肝衰竭患者的住院时间显著长于急性肝衰竭患者（天数：36.00±8.31，27.52±11.71，27.72±22.71 vs. 11.00±1.41，均P<0.05）。HBV衰竭组和非HBV衰竭组使用人工肝支持系统的病死率差异无统计学意义（55.6% vs. 50.0%，P<0.05），两组存活患者的AT III水平显著高于死亡患者[HBV肝衰竭组：（36.20±6.26）% vs.（27.33±8.87）%，非HBV肝衰竭组：（41.06±4.16）% vs.（28.71±12.35）%，均P<0.01]。相关性分析显示，HBV肝衰竭组死亡患者以及非HBV肝衰竭组存活与死亡患者中，AT III与TBil之间均存在明显正相关（r值分别为0.069、0.341、0.064，P值分别为0.723、1.196、0.761）；HBV肝衰竭组中AT III与TBil之间存在显著负相关（r=-0.105，P=0.745）。多因素Logistic回归分析显示，AT III是影响非HBV肝衰竭患者预后的独立危险因素[比值比（OR）=1.023，95%置信区间（95%CI）为-0.001至0.001，P=0.007]。TBil是影响HBV肝衰竭患者预后的独立危险因素（OR=1.005，95%CI为-0.002至-7.543，P=0.033）。ROC曲线分析显示，AT III对非HBV肝衰竭患者的预后具有预测价值，ROC曲线下面积（AUC）=0.747，95%CI为0.592-0.902，P=0.009。当最佳截断值为39.5%时，其敏感性和特异性分别为83.33%和56.25%。
人工肝支持系统治疗肝衰竭难以有效降低终末期肝衰竭患者的死亡率。除AT III外，TBil也可作为评估肝衰竭患者肝脏代偿能力和预测预后的指标。
