急性肝衰竭患者预后的影响因素及预测价值

作者： style="font-size: 12px ">刘雨薇 1 蒋琳 1 郭濛濛 1 段方方 2 杨松 3

单位：1. 首都医科大学附属北京地坛医院 急诊科 北京 100015 2. 首都医科大学附属北京地坛医院 肝病中心 北京 100015 3. 青海省第四人民医院 肝病科 青海 西宁 810000

关键词：急性肝衰竭 凝血酶原活动度 预后

分类号：

出版年,卷(期):页码：2026,18(1):72-78

摘要：

摘要：目的 探讨急性肝衰竭（acute liver failure，ALF）患者的临床特征，并分析其住 院期间治疗转归的影响因素。方法 回顾性分析 2010 年 11 月 1 日至 2021 年 7 月 31 日 在首都医科大学附属北京地坛医院因各种病因就诊并明确诊断为 ALF 患者的病历资 料，根据治疗效果将患者分为好转组和无效组，比较两组患者基线白蛋白（albumin， Alb）、白细胞（white blood cell，WBC）、血小板（platelet，PLT）、丙氨酸氨基转移 酶（alanine transaminase，ALT）、天冬氨酸氨基转移酶（aspartate transaminase，AST）、 总胆红素（total bilirubin，TBil）、直接胆红素（direct bilirubin，DBil）、γ-谷氨酰转移 酶（gamma-glutamyl transferase，GGT）、 碱 性 磷 酸 酶（alkaline phosphatase，ALP）、 血氨、肌酐、凝血酶原时间（prothrombin time，PT）、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（alpha-fetoprotein，AFP）水平的差异。采用单因素和多因素 Logistic 回归分析 ALF 预后的影响因素。采用受试者工作特征（receiver operator characteristic，ROC）曲线分 析各影响因素对 ALF 预后的预测价值。结果 本研究共纳入 128 例 ALF 患者，好转组 44 例，无效组 84 组。ALF 的主要病因为病毒性肝炎（55/128），发病季节主要集中 在夏季（36/128）；无效组患者 ln （TBil）（中位数：2.33 μmol/L 比 2.28 μmol/L）、血 氨（中位数：51.00 mmol/L 比 42.00 mmol/L）、PT（中位数：43.40 s 比 31.20 s）、INR （中位数：4.20 比 2.69）、消化道出血比例［33%（28/84）比 16%（7/44）］、急性肾衰 竭比例［30%（25/84） 比 14%（6/44）］、 脑 水 肿 比 例［5%（2/44） 比 23%（19/84）］、 Ⅱ级肝性脑病比例［72%（32/44）比 51%（43/84）］均显著高于好转组，GGT（中位 数：76.80 U/L 比 101.70 U/L）和 PTA（中位数：13.10% 比 25.00%）均显著低于好转组 （P 均 ＜ 0.05）。 多 因 素 Logistic 回 归 分 析 表 明， 脑 水 肿（OR = 5.318，95%CI： 1.073～26.310，P = 0.041）和 ln（TBil）（OR = 8.442，95%CI：1.744～40.864，P = 0.008） 是 ALF 患者预后不佳的独立危险因素，PTA 是保护因素（OR = 0.918，95%CI：0.881～ 0.957，P ＜ 0.001）。脑水肿、ln （TBil）、 PTA联合预测ALF预后的ROC曲线下面积为 0.804 （95%CI：0.712～0.877），特异度为 75.41%，敏感度为 84.21%。结论 脑水肿、TBil 升 高是 ALF 患者预后不佳的独立危险因素，PTA 升高是保护因素，3 项指标联合对 ALF 预后具有一定预测价值。

Abstract: Objective To investigate the clinical characteristics of patients with acute liver failure (ALF) and to analyze the factors affecting the treatment outcomes during hospitalization. Methods A retrospective analysis was conducted on the medical records of patients with a confirmed diagnosis of ALF who sought medical care for various etiologies at Beijing Ditan Hospital, Capital Medical University from November 1st, 2010 to July 31st, 2021. The patients were divided into recovery group and poor-outcome group according to treatment outcomes. The differences in baseline levels of albumin (Alb), white blood cell (WBC), platelet (PLT), alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBil), direct bilirubin (DBil), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), blood ammonia, creatinine, prothrombin time (PT), prothrombin time activity (PTA), international normalized ratio (INR) and alpha-fetoprotein (AFP) were compared between the two groups. Univariate and multivariate Logistic regression analysis were performed to identify the influencing factors for ALF prognosis. The receiver operator characteristic (ROC) curve was applied to analyze the predictive value of each influencing factor for ALF prognosis. Results A total of 128 patients with ALF were enrolled in this study, with 44 cases in recovery group and 84 cases in poor-outcome group. The primary etiology of ALF was viral hepatitis (55/128), and the onset of the disease was mainly concentrated in summer (36/128). The levels of ln (TBil) (median: 2.33 μmol/L vs. 2.28 μmol/L), blood ammonia (median: 51.00 mmol/L vs. 42.00 mmol/L), PT (median: 43.40 s vs. 31.20 s), INR (median: 4.20 vs. 2.69), the proportion of gastrointestinal bleeding [33% (28/84) vs. 16% (7/44)], the proportion of acute renal failure [30% (25/84) vs. 14% (6/44)], the proportion of cerebral edema [5% (2/44) vs. 23% (19/84)] and the proportion of grade Ⅱ hepatic encephalopathy [72% (32/44) vs. 51% (43/84)] in poor-outcome group were all significantly higher than those in the recovery group, while GGT (median: 76.80 U/L vs. 101.70 U/L) and PTA (median: 13.10% vs. 25.00%) were significantly lower than those in the recovery group (all P ＜ 0.05). Multivariate Logistic regression analysis showed that cerebral edema (OR = 5.318, 95%CI: 1.073～26.310, P = 0.041) and elevated ln (TBil) (OR = 8.442, 95%CI: 1.744～40.864, P = 0.008) were independent risk factors for poor prognosis in ALF patients, while elevated PTA was a protective factor (OR = 0.918, 95%CI: 0.881～0.957, P ＜ 0.001). The area under the ROC curve of combined detection of cerebral edema, ln (TBil) and PTA for predicting ALF prognosis was 0.804 (95%CI: 0.712～0.877, P ＜ 0.001), with a specificity of 75.41% and a sensitivity of 84.21%. Conclusions Cerebral edema and elevated TBil were independent risk factors for poor prognosis in patients with ALF, while elevated PTA was a protective factor. The combined detection of these three indicators had a certain predictive value for the prognosis of ALF.

基金项目：

作者简介：

参考文献：

服务与反馈：

【文章下载】【加入收藏】