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摘要：
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摘要：目的 探讨TACIA评分对乙型肝炎病毒感染相关慢加急性肝衰竭（hepatitis B virus
infection-associated acute-on-chronic liver failure，HBV-ACLF）患者预后的预测价值。方
法 以2020年1月1日至2022年12月31日于湖北医药学院附属人民医院住院治疗的136例
HBV-ACLF患者为研究对象进行回顾性分析。根据治疗效果分为有效组（100例）和无
效组（36例）。记录两组患者的临床资料、白细胞（white blood cell，WBC）、血小板
（platelet，PLT）、红细胞（red blood cell，RBC）、血红蛋白（hemoglobin，HGB）、
丙氨酸氨基转移酶（alanine aminotransferase，ALT）、天冬氨酸氨基转移酶（aspartate
aminotransferase，AST）、总胆红素（total bilirubin，TBil）、白蛋白（albumin，Alb）、
血清前白蛋白（prealbumin，PAB）、血浆凝血酶原时间（prothrombin time，PT）、血
肌酐（serum creatinine，sCr）、HBV DNA、凝血酶原活动度（prothrombin time activity，
PTA）、国际标准化比值（international normalized ratio，INR）、甲胎蛋白（alphafetoprotein，
AFP）等。计算TACIA评分及终末期肝病模型（model for end-stage liver
disease，MELD）评分。采用多因素Logistic回归分析HBV-ACLF患者预后的影响因素。采
用受试者工作特征（receiver operator characteristic，ROC）曲线分析AFP、TACIA评分、
MELD评分单用或联合对判断HBV-ACLF预后的价值。结果 有效组和无效组患者自发性
细菌性腹膜炎（26.00%比47.22%）、腹水（56.00%比80.56%）、肝性脑病（12.00%比
61.11%）、肝肾综合征（2.00%比16.67%）、肝硬化（42.00%比66.67%）、HBV DNA阳
性（85.00%比69.44%）构成比，PT（中位数：20.60 s比24.75 s）、INR（中位数：1.82比
2.20）、PTA（中位数：42.65%比34.00%）、TBil（中位数：217.35 μmol/L比295.10 μmol/L）、AFP
（中位数：43.30 μg/L比22.70 μg/L）、TACIA评分（中位数：3.90分比4.75分）及MELD
评分（中位数：22.35分比25.15分）差异有统计学意义（P均＜ 0.05）。多因素Logistic回
归分析表明AFP（OR = 0.996，95%CI：0.991～1.000，P = 0.048）是HBV-ACLF预后的独
立保护因素，肝性脑病（OR = 11.524，95%CI：4.678～28.388，P ＜ 0.001）和TACIA评
分（OR = 5.350，95%CI：2.004～14.286，P ＜ 0.001）是独立危险因素。AFP、TACIA
评分、MELD评分、AFP联合TACIA评分、MELD联合TACIA评分预测HBV-ACLF预后
的ROC曲线下面积分别为0.669、0.733、0.699、0.736、0.739，敏感度分别为61.00%、
82.00%、68.00%、80.00%、85.00%，特异度分别为69.44%、63.89%、66.67%、63.89%、
61.11%，约登指数分别为0.304、0.459、0.347、0.439、0.461。结论 TACIA评分是预测
HBV-ACLF预后的有效指标。
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Abstract: Objective To investigate the predictive value of TACIA score on prognosis of patients
with hepatitis B virus infection-associated acute-on-chronic liver failure (HBV-ACLF). Methods
A retrospective analysis was performed on 136 patients with HBV-ACLF who were hospitalized
in Shiyan People’s Hospital, Hubei University of Medicine from January 1st, 2020 to December
31st, 2022. The patients were divided into effective group (100 cases) and ineffective group (36
cases) according to the treatment effect. Clinical data, white blood cells (WBC), platelets (PLT),
alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), albumin
(Alb), serum prealbumin (PAB), plasma prothrombin time (PT), serum creatinine (sCr), HBV DNA,
prothrombin activity (PTA), international standardized ratio (INR) and alpha-fetoprotein (AFP) of
patients in each group were collected. TACIA score and model for end-stage liver disease (MELD)
score were calculated. Multivariate Logistic regression analysis was used to analyze the influence
factors of prognosis in patients with HBV-ACLF. Receiver operating characteristic (ROC) curve
was used to analyze the value of AFP, TACIA and MELD alone or in combination for predicting
the prognosis of HBV-ACLF. Results Patients in effective group and ineffective group showed
statistically significant differences (all P ＜ 0.05) in the constituent ratios of spontaneous bacterial
peritonitis (26.00% vs. 47.22%), ascites (56.00% vs. 80.56%), hepatic encephalopathy (12.00%
vs. 61.11%), hepatorenal syndrome (2.00% vs. 16.67%), liver cirrhosis (42.00% vs. 66.67%) and
HBV DNA positivity (85.00% vs. 69.44%), as well as in the median values of PT (20.60 s vs. 24.75 s),
INR (1.82 vs. 2.20), PTA (42.65% vs. 34.00%), TBil (217.35 μmol/L vs. 295.10 μmol/L), AFP (43.30 μg/L
vs. 22.70 μg/L), TACIA score (3.90 points vs. 4.75 points) and MELD score (22.35 points vs.
25.15 points). Multivariate Logistic regression analysis showed that AFP (OR = 0.996, 95%CI:
0.991～1.000, P = 0.048) was an independent protective factor for prognosis of HBV-ACLF, and
hepatic encephalopathy (OR = 11.524, 95%CI: 4.678～28.388, P ＜ 0.001) and TACIA score (OR =
5.350, 95%CI: 2.004～14.286, P ＜ 0.001) were independent risk factors. The areas under the ROC
curve for AFP, TACIA score, MELD score, AFP combined with TACIA score and MELD combined
with TACIA score in predicting the prognosis of HBV-ACLF were 0.669, 0.733, 0.699, 0.736
and 0.739, respectively. The sensitivities were 61.00%, 82.00%, 68.00%, 80.00% and 85.00%,
respectively; the specificities were 69.44%, 63.89%, 66.67%, 63.89% and 61.11%, respectively and
the Youden indices were 0.304, 0.459, 0.347, 0.439 and 0.461, respectively. Conclusion TACIA
score was an effective indicator for predicting the prognosis of HBV-ACLF.
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