血清肌酐与胱抑素C比值（CCR）对HBV相关慢加急性肝衰竭预后的评估价值.docx
病毒性肝炎l：10.12449XH240208血清肌酊与胱抑素C比值(CCR)对HBV相关慢加急性肝衰竭预后的评估价值刘大晴，黄燕，甘建和苏州大学附属第一医院感染病科，江苏苏州215000通信作者：甘建和，ganjianhe2023(163.m(ORCID:0009-0001-3837-2745)摘要：目的探讨血清肌肝与胱抑素C比值(CCR)评估HBV相关慢加急性肝衰竭(HBV-ACLF)预后的I随床价值。方法回顾性分析2021年1月一2022年11月苏州大学附属第一医院感染病科住院治疗的130例HBV-ACLF患者(治疗组)临床资料，根据治疗结局分为生孕S(n=87)和死亡组(n=43);根据是否合并感，分为联组(n=37)和三睢顺(n=93)以同期30例健康体检者作为对照组。收集入院当天血常规指标，包括白细胞、血班、中性粒细胞和淋巴细胞计数；观察入院当天、住!踊5天、第10天、第15天血清fl/1酰胱抑素C、血清Alb、PT,计算CCR、中邮细胞与淋巴细胞比值(NLR)、血小板与淋巴迪匕值(PLR)、营I(PNI)、CCR5(入5天CCR)、ACCR5(5天8RCCR)、CCR10(M。天8R)、ACCRlO(AMlo天CCR-lM5天CCR)、CCRI5(15天CCR)、CCR15(15CCR-入院后第10天CCR),比较生存组和死亡组、感染组与非感染组上述指标的差异。计量资料两组间比较采用Mann-WhimeyU检验；多组间比较采用Kruskal-WallisH检验.单因素和多因素Logistic回归分析探讨影响疾病预后的因素；受试者工作特征曲线(ROC曲线)评估CCR对HBV-ACLF死亡事件的预测M介值，R曲线下面积(AUC)匕檄采用DeLong脸o结果治疗组基线CCR.NLR、PNkPT和Alb与健康对照组匕蹴，差异均有统计学意义(产值均0.001)生存组与死亡组患者入院当天CCR、NLRxPTh徽，差异均有统计学意义(产值均0.05).在130例HBV-ACLF患者中，有25例处于前期，48例处于早期，32例处于中期，25例处于晚期各分期HBV-ACLF患者辘CCR.PLR及PT膜，差异均有统计学意义(尸值均0.05)感嵋与隐染组患者期ACCR5、NLR比较，差异均有统计学意义(产值均0.05)。患者入院第5天、第10天、第15天生CCRl0、CCRl5匕盛，差统三005).多SmLDgiStiC回肠析频ACCR5(1.175,95%C:1.098-1.256,FkO.001),NLR(OR=O.921,95%C:08800.964,网.001)和PT(C«=0.921,95%C:0.8730.973,P=O.003)是HBV-ACLF患者预后的独立影响因素CCR5的AUC为0.774,敏感度为0.687,特异度为0.757;ACCR5+PT+NLRg的AUC为0.824,高于ACCR5NLR.PT单瞰IBAUC(P顾0.05)。雌ACCR5、NLR.PTrJ反映HBV-ACLF患者的病情及预后,是HBV-ACLF患者死亡事件的独立预测指标，ACCR5+PT+NLR联合时预测效能最佳。关键词：乙型肝炎病毒；慢加急性肝功能衰竭；肌酸醉；半胱氨酸蛋白酶抑制物C；预后基金项目：“十三五"国家科技重大专项(2017ZX10203201002-002)Valueofserumcreatinine-to-cystatinCratioinassessingtheprognosisofhepatitisBvirus-relatedacute-on-chronicliverfailure1.IUDaqing,HUANGYan,GANJianhe.(DepartmentOflnfectiousDiseases,TheFirstAffiIiatedHospitalofSoochowUniversity,SuzhoulJiangsu2150001China)Correspondingauthor:GANJianhe,ganpanhe2023(g)163,m(ORCID:0009-0001-3837-2745)Abstract:ObjectiveToinvestigatetheclinicalvalueofserumcreatinine-to-cystatinCratio(CCR)inevaluatingtheprognosisofhepatitisBvirus-relatedacute-on-chronicliverfailure(HBV-ACLF).MethodsAretrospectiveanalysiswasperformedfortheclinicaldataof130patientswithHBV-ACLF(treatmentgroup)whowerehospitalizedinDepartmentofInfectiousDiseases,TheFirstAffiliatedHospitalofSOOChoWUniversity,fromJanuary2021toNovember2022.Accordingtothetreatmentoutme,theyweredividedintosurvivalgroupwith87patientsanddeathgroupwith43patients;acrdingtothepresenceorabsenceofinfection,theyweredividedintoinfectiongroupwith37patientsandnon-infectiongroupwith93patients.Atotalof30individualswhounderwentphysicalexaminationduringthesameperiodoftimewereenrolledasntrolgroup.Routinebloodtestresultswerecollectedonthedayofadmission,includingwhitebloodcellcount,plateletcount,neutrophilcount,andlymphytent;serumcreatinine,cystatinC,serumalbumin(Alb),andprothrombintime(PT)wereobservedonthedayofadmissionandondays5r10,and15ofhospitalization,andrelatedindicatorswerecalculated,includingCCR,neutrophil-to-lymphocyteratio(NLR),platelet-to-lymphocyteratio(PLR),prognosticnutritionalindex(PNI),CCR5(CCROnday5afteradmission),CCR5(CCRonday5afteradmissiminusCCROnthedayofadmission),CCR10(CCRonday10afteradmission),CCR10(CCROnday10afteradmissionminusCCRonday5afteradmission),CCR15(CCRonday15afteradmission),andCCR15(CCROnday15afteradmissionminusCCRonday10afteradmission).Theaboveindicatorsweremparedbetweenthesurvivalgroupandthedeathgroupandbetweentheinfectigroupandthenon-infectiongroup.TheMann-WhitneyUtestwasusedformparisonofntinuousdatabetweentwogroups,andtheKnjskal-WallisHtestwasusedforcomparisonbetweenmultiplegroups.Theunivariateandmultivariatelogisticregressionanalyseswereusedtoinvestigateteinfluencingfactorsfordiseaseprognosis;thereceiveroperatingcharacteristic(ROC)curvewasusedtoassessthevalueofCCRinpredictingHBV-ACLFdeathevents,andtheDeLongtestwasusedforcomparisonoftheareaundertheROCCUrVe(AUC).ResultsThereweresignificantdifferencesinCCR,NLR,PNI,PTfandAlbatbaselinebetweenthetreatmentgroupandthehealthycontrolgroup(allBd).001),andthereweresignificantdifferencesinCCR,NLR,andPTbetweenthesurvivalgrcjpandthedeathgrouponthedayofadmission(allP<0.05).Amongthe130patientswithHBV-ACLF,therewere25intheprecancerousstage,48intheearlystage,32intheintermediatestage,and25intheadvancedstage,andthereweresignificantdifferencesinbaselineCCR,PLR,andPTbetweenthepatientsindifferentstagesofHBV-ACLF(allP<0.05).ThereweresignificantdifferencesinCCR5andNLRbetweentheinfectiongroupandthenon-infectiongroup(P<0.05),andthereweresignificantdifferencesinCCR5,CCR10,andCCR15betweenthesurvivalgroupandthedeathgroup(allPCo.05).ThemultivariatelogisticregressionanalysisshowedthatCCR5(OddsratioOR=1.175,95%confideninte<valCl:1.098-1256,P<Q.Q01),NLR(OA).921,95%C:0.8800.964,P<0.001),andPT(OR=0.921,95%C:0.8730.973,P=0.003)wereindependentinfluencingfactorsfortheprognosisofHBV-ACLFpatients.CCR5hadanAUCof0.774,asensitivityof0.687,andaspecificityof0.757,andtheAUCofCCR5+PT+NLRwas0.824,whichwassignificantlyhigherthantheAUCofCCR5,NLR,orPTalone(allP<0.05).ConclusionCCR5,NLR,andPTcanreflectthenditionandprognosisofpatientswith
