NLR联合MLR对乙型肝炎病毒相关慢加急性肝衰竭患者人工肝治疗短期预后的预测价值*

Predictive value of NLR combined with MLR in short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure treated with artificial liver*

摘要:

目的 探讨中性粒细胞-淋巴细胞比例（NLR）联合单核细胞-淋巴细胞比例（MLR）预测乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）患者人工肝治疗短期预后的预测价值。方法 回顾性分析2016年1月—2019年6月广西壮族自治区民族医院收治的81例第一次行人工肝治疗的HBV-ACLF患者，根据90?d的预后情况将患者分为生存组63例和死亡组18例。采用多因素Logistic回归分析各相关因素与人工肝治疗的HBV-ACLF患者疾病转归的关系，通过绘制受试者工作特征（ROC）曲线分析NLR联合MLR的ROC曲线下面积（AUC），评估两者联合预测HBV-ACLF患者人工肝治疗短期预后的价值。结果 人工肝治疗死亡组的血清总胆红素（TBIL）、肌酐、国际标准化比值（INR）、终末期肝病模型（MELD）评分、NLR、MLR、C反应蛋白（CRP）均高于生存组（P?<0.05），凝血酶原活动度（PTA）低于生存组（P?<0.05）。多因素Logistic回归分析结果示：NLR [OlR=3.719（95% CI：3.525，3.942）]和MLR[OlR=2.335（95% CI：2.161，2.596）]为预测HBV-ACLF 患者人工肝治疗90 d短期预后的危险因素，PTA [OlR=0.729（95% CI：0.550，0.967）]为预测其预后的保护因素。AUC显示：NLR联合MLR的AUC相对最高，为0.921（95% CI：0.876，0.966）。NLR联合MLR可提高预测人工肝治疗的HBV-ACLF患者短期预后的敏感性[76.0%（95% CI：0.723，0.806）和特异性[92.0%（95% CI：0.882，0.957）]。结论 PTA和系统性炎症指标（NLR、MLR）与HBV-ACLF患者人工肝治疗短期预后密切相关。

Abstract:

Objective To investigate the value of neutrophil-lymphocyte ratio (NLR) combined with monocyte-lymphocyte ratio (MLR) in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) treated with artificial liver. Methods A retrospective analysis was performed for the clinical data of 81 who received artificial liver therapy for the first time from January 2016 to June 2019 in National Hospital of Guangxi Zhuang Autonomous Region, according to the prognosis at 90 days after the first artificial liver treatment, and these patients were divided into survival group with 63 patients and death group with 18 patients. Multivariate logistic regression was used to analyze the association of related factors with the prognosis of HBV-ACLF patients treated with artificial liver. The area under the ROC curve (AUC) of NLR combined with MLR was used to evaluate the value of NLR combined with MLR in predicting the short-term prognosis of HBV-ACLF patients treated with artificial liver. Results Compared with the survival group, the death group had significantly higher TBIL, creatinine, INR, MELD scores, NLR, MLR and CRP and a significantly lower prothrombin time activity (PTA) (P?