声触诊组织量化技术结合COSSH-ACLF评分预测乙型病毒性肝炎相关慢加急性肝衰竭患者预后的价值

The value of acoustic palpation tissue quantification technology combined with COSSH-ACLF score in predicting the prognosis of HBV related chronic and acute liver failure patients

摘要:

目的 探讨声触诊组织量化技术结合中国器官移植协会-慢加急性肝衰竭（COSSH-ACLF）评分预测乙型病毒性肝炎（HBV）相关ACLF患者预后的价值。方法 选取2020年1月—2023年1月南京市中医院收治的76例HBV相关慢加急性肝衰竭（ACLF）患者的病历资料进行回顾性分析。以患者住院30 d内死亡或病情恶化后自主放弃治疗为研究终点，将患者分为转归组与死亡/恶化组。采用多因素逐步Logistic回归模型分析HBV相关ACLF患者预后的影响因素。绘制受试者工作特征（ROC）曲线分析COSSH-ACLF评分、声触诊组织量化技术中肝脏剪切波速度对HBV相关ACLF患者预后的预测价值。结果 76例HBV相关ACLF患者病情转归35例，死亡/恶化41例。死亡/恶化组并发肝性脑病的占比高于转归组（P <0.05）。死亡/恶化组患者的HBV-DNA水平、COSSH-ACLF评分、肝脏剪切波速度高于转归组（P <0.05）。多因素逐步Logistic回归分析结果显示，并发肝性脑病［O^R=2.992（95% CI：1.023，8.754）］、HBV-DNA水平高［O^R=3.515（95% CI：1.201，10.283）］、COSSH-ACLF评分高［O^R=4.768（95% CI：1.629，13.951）］、肝脏剪切波速度快［O^R=4.019（95% CI：1.374，11.758）］均是HBV相关ACLF预后的危险因素（P <0.05）。COSSH-ACLF评分、肝脏剪切波速度单一及联合预测HBV相关ACLF预后的敏感性分别为65.85%（95% CI：0.599，0.760）、78.05%（95% CI：0.654，0.823）、82.93%（95% CI：0.678，0.902），特异性分别为68.57%（95% CI：0.600，0.762）、65.71%（95% CI：0.574，0.740）、77.14%（95% CI：0.641，0.816），曲线下面积分别为0.704、0.718和0.829。结论 COSSH-ACLF评分、肝脏剪切波速度可用于预测HBV相关ACLF患者的预后结局。

Abstract:

Objective To explore the value of acoustic palpation tissue quantification technology combined with the Chinese Group on the Study of Severe Hepatitis B Acute-on-Chronic Liver Failure (COSSH-ACLF) score in predicting the prognosis of patients with hepatitis B (HBV) related ACLF.Methods A retrospective analysis was conducted on the medical records of 76 HBV related ACLF patients admitted to our hospital from January 2020 to January 2023. The study endpoint was death within 30 days of hospitalization or voluntary abandonment of treatment after deterioration of the condition. Patients were divided into outcome group and death/deterioration group. The factors affecting the progression of the patient's condition were analyzed, and the predictive value of COSSH-ACLF score and liver shear wave velocity in acoustic palpation tissue quantification technology on the prognosis of HBV related ACLF patients was evaluated.Results Out of 76 patients with HBV related ACLF, 35 experienced disease progression and 41 died/worsened. The proportion of patients with hepatic encephalopathy in the two groups was compared, and the difference was statistically significant (P < 0.05), with the death/deterioration group having a higher proportion than the recovery group. The HBV-DNA levels, COSSH-ACLF scores, and liver shear wave velocity between the death/deterioration group and the recovery group were compared using the t-test, and the difference was statistically significant (P < 0.05), with the death/deterioration group having higher HBV-DNA levels, COSSH-ACLF scores, and liver shear wave velocity than the recovery group. Concurrent hepatic encephalopathy [O^R =2.992 (95% CI: 1.023, 8.754) ], high HBV-DNA levels [O^R =3.515 (95% CI: 1.201, 10.283) ], high COSSH-ACLF score [O^R =4.768 (95% CI: 1.629, 13.951) ], and high liver shear wave velocity are all risk factors for the prognosis of HBV related ACLF (P <0.05). The sensitivity of COSSH-ACLF score, liver shear wave velocity alone, and combined prediction of HBV related ACLF prognosis were 65.85% (95% CI: 0.599, 0.760), 78.05% (95% CI: 0.654, 0.823), 82.93% (95% CI: 0.678, 0.902), specificity were 68.57% (95% CI: 0.600, 0.762), 65.71% (95% CI: 0.574, 0.740), 77.14% (95% CI: 0.641, 0.816), and AUC were 0.704, 0.718, and 0.829, respectively.Conclusion The COSSH-ACLF score and liver stiffness measurement can be used to predict the prognosis of HBV-related ACLF patients.