中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (03): 221-226.doi: 10.3969/j.issn.1671-4091.2023.03.014

• 人工肝 • 上一篇    下一篇

人工肝血浆透析滤过干预启动时间与乙型肝炎相关性慢加急性肝衰竭患者院内预后之间的关联

林建辉   陈丽霞    蓝丽琴   刘宝荣    林銮锋   俞晓玲   刘海钰   

  1. 350001 福州，福建医科大学孟超肝胆医院1重症医学科 2感染科 3药学部
    350001 福州， 4福建医科大学协和临床医学院
  • 收稿日期:2022-10-08 修回日期:2023-01-09 出版日期:2023-03-12 发布日期:2023-03-03
  • 通讯作者: 林建辉 E-mail:cnfjljh@163.com
  • 基金资助:
    北京肝胆相照公益基金会人工肝专项(RGGJJ-2021-006)；福建省自然科学基金(2021J011293)

Association between the initial time of artificial liver plasma dialysis filtration intervention and the in-hospital prognosis in patients with hepatitis B-related chronic onset acute liver failure

LIN Jian-hui, CHEN Li-xia, LAN Li-qin, LIU Bao-rong, LIN Luan-feng, YU Xiao-ling, LIU Hai-yu   

  1. Department of Critical Care Medicine, 2Department of Infectious Diseases, 3Department of Pharmacy, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350001, China; 4Union Medical College of Fujian Medical University, Fuzhou 350001, China
  • Received:2022-10-08 Revised:2023-01-09 Online:2023-03-12 Published:2023-03-03
  • Contact: 350001 福州，福建医科大学孟超肝胆医院1重症医学科 E-mail:cnfjljh@163.com

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摘要： 目的  探索人工肝血浆透析滤过(plasma diafifiltration，PDF)干预启动时间与乙型肝炎相关慢加急性肝衰竭(HBV-related acute-on-chronic liver failure，HBV-ACLF)患者院内预后之间的关联。 方法  选取2017年01月01日～2021年12月31日确诊HBV-ACLF的患者，按院内预后分为改善组与未改善组，对2组人口统计学、基线实验室检查及院内预后等通过单因素及多因素Logistic回归分析确立独立影响因素，平滑曲线拟合探索PDF干预启动时间与院内预后的关联。 结果  共纳入88例患者，改善组60例(68.2%)，单因素Logistic回归分析显示PDF干预启动时间(OR=1.03，95% CI：1.01～1.04，P＜0.001)、年龄(OR=1.06，95% CI：1.02～1.11，P=0.005)、基线血丙氨酸氨基转移酶(OR=1.00，95% CI：1.00～1.00，P=0.012)、基线合并腹腔感染(OR = 3.13，95% CI：1.20～8.14，P=0.019)是可能的影响因素；多因素Logistic回归分析显示PDF干预启动时间(OR=1.04，95% CI：1.02～1.05，P＜0.001)、年龄(OR=1.08，95% CI：1.01～1.14，P=0.038)、HBV-ACLF早期(OR=0.13，95% CI：0.02～0.98，P=0.048)是院内不良预后的独立影响因素；PDF干预启动时间与院内不良预后之间可能存在阈值效应；分段回归模型显示最佳阈值为72小时，小于72小时OR=0.75，95% CI：0.53～1.05，P =0.089；大于72小时OR =1.04，95% CI：1.02～1.06，P＜0.001。 结论  PDF干预启动时间与患者院内不良预后之间存在阈值效应，确诊HBV-ACLF后72小时以内完善手术前评估并立即启动PDF干预可能是潜在的临床救治时机之一。

关键词: 乙型肝炎, 慢加急性肝衰竭, 人工肝, 血浆透析滤过, 干预时间

Abstract: Objective  To explore the relationship between the start time of plasma diafiltration (PDF) intervention with artificial liver and the in-hospital prognosis of the patients with hepatitis B-related acute chronic liver failure (HBV-ACLF).  Methods  The patients diagnosed with HBV-ACLF from January 1 2017 to December 31, 2021 were selected and divided into an improved group and a non-improved group according to their in-hospital prognosis. Univariate and multivariate logistic regression analyses were performed using their demographics, baseline laboratory examinations, and in-hospital prognosis of the two groups to obtain the independent influencing factors. Smooth curve fitting was used to explore the correlation between start time of PDF and in-hospital prognosis.  Results  A total of 88 patients were included, with 60 patients in the improved group (68.2%). Univariate logistic regression showed that start time of PDF intervention (OR=1.03,95% CI: 1.01~1.04,P＜0.001), age (OR=1.06, 95% CI:1.02~1.11,P=0.005), baseline blood alanine aminotransferase (OR=1.00, 95% CI:1.00~1.00, P=0.012), and baseline abdominal infection (OR=3.13, 95% CI: 1.20~8.14, P=0.019) were the possible influencing factors for in-hospital prognosis. Multivariate logistic regression showed that the start time of PDF intervention (OR=1.04,95% CI: 1.02~1.05,P＜0.001), age (OR=1.08,95% CI:1.01~1.14, P=0.038), and HBV-ACLF at an early stage (OR=0.13, 95% CI:0.02~0.98,P=0.048) were the independent influencing factors for adverse in-hospital prognosis. There may be a threshold effect between the start time of PDF intervention and adverse in-hospital prognosis. The segmented regression model showed that the optimal threshold was 72 hours, less than 72 hours with the OR=0.75 (95% CI: 0.53~1.05,P=0.089), and more than 72 hours with the OR=1.04(95% CI:1.02~1.06,P＜0.001).  Conclusion  There was a threshold effect between the start time of PDF intervention and the adverse in-hospital prognosis of the patients. Preoperative evaluation and initiation of PDF intervention within 72 hours after the diagnosis of HBV-ACLF may be one of the potential opportunities of clinical treatment.

Key words: Hepatitis B, Acute-on-chronic liver failure, Artificial liver, Plasma diafiltration, Intervention time

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