通讯作者: 相伟英, xwy19880530@163.com

DOI：10.12201/bmr.202409.00056

• 摘要：目的 研究慢性乙型肝炎肝硬化失代偿期继发急性肾损伤的危险因素并分析其预后。方法 选择2018年1月至2024年1月诊治316例慢性乙型肝炎肝硬化失代偿期患者为研究对象,根据患者是否继发急性肾损伤分为慢性乙型肝炎肝硬化失代偿期组(CHBCD组)和慢性乙型肝炎肝硬化失代偿期继发急性肾损伤组(CHBCD+AKI组)。比较CHBCD组和CHBCD+AKI组患者临床病理特征的差异。Spearman秩相关分析临床病理特征与Scr、BUN的相关性。多因素Cox回归分析慢性乙型肝炎肝硬化继发急性肾损伤的危险因素。受试者工作特征(ROC)曲线分析危险因素预测慢性乙型肝炎肝硬化继发急性肾损伤患者的效能。采用Kaplan-Meier生存模型及Log rank比较CHBCD组和CHBCD+AKI组患者生存期的差异。结果 CHBCD组和CHBCD+AKI组患者在肝性脑病、PT、Alb、TBIL、Scr、BUN、Cys-C、Child-Pugh分级、MELD评分、LSM方面的差异有统计学意义(P<0.05)。CHBCD+AKI组患者肝性脑病率、PT、TBIL、Scr、BUN、Cys-C、Child-Pugh分级C级比例、MELD评分、LSM显著高于CHBCD组患者(P<0.05),Alb显著低于CHBCD组患者(P<0.05)。CHBCD+AKI组患者肝性脑病、PT、TBIL、Cys-C、Child-Pugh分级、MELD评分、LSM与Scr、BUN呈正相关(均rs>0,P<0.05),与Alb呈负相关(均rs<0,P<0.05)。Scr≥467.2μmol/L、BUN≥11.5mmol/L、Cys-C≥2.7mg/L、Child-Pugh分级C级、MELD评分≥15.4、LSM≥26.5kPa均为慢性乙型肝炎肝硬化失代偿期继发急性肾损伤的独立危险因素(P<0.05)。BUN、Cys-C、MELD评分、LSM在预测慢性乙型肝炎肝硬化失代偿期继发急性肾损伤中的敏感度、特异度及AUC高于Scr、Child-Pugh分级。CHBCD+AKI组患者中位生存期显著低于CHBCD组患者(中位生存期17.3±3.5月比26.5±4.7月,Log Rank=17.248,P<0.001)。结论 Scr、BUN、Cys-C、Child-Pugh分级、MELD评分及LSM为慢性乙型肝炎肝硬化失代偿期继发急性肾损伤的独立危险因素,慢性乙型肝炎肝硬化失代偿期继发急性肾损伤生存期显著降低。

  关键词： 慢性乙型肝炎; 肝硬化; 失代偿期; 急性肾损伤; 危险因素

   

  Abstract: Objective To investigate the risk factors for acute kidney injury secondary to decompensated cirrhosis of chronic hepatitis B and analyze its prognosis. Methods 316 patients with decompensated cirrhosis of chronic hepatitis B who were treated from January 2018 to January 2024 were selected as the research subjects. According to whether the patients had secondary acute kidney injury, they were divided into decompensated cirrhosis of chronic hepatitis B group (CHBCD group) and decompensated cirrhosis of chronic hepatitis B group with acute kidney injury (CHBCD+AKI group). The differences in clinicopathological characteristics between the CHBCD group and the CHBCD+AKI group were compared. Spearman rank correlation analysis was used to analyze the correlation between clinicopathological characteristics and Scr and BUN. Multivariate Cox regression analysis was used to analyze the risk factors for acute kidney injury secondary to chronic hepatitis B cirrhosis. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of risk factors in predicting acute kidney injury secondary to chronic hepatitis B cirrhosis. The Kaplan-Meier survival model and Log rank were used to compare the survival of patients in the CHBCD group and the CHBCD+AKI group. Results There were significant differences in hepatic encephalopathy, PT, Alb, TBIL, Scr, BUN, Cys-C, Child-Pugh grade, MELD score, and LSM between the CHBCD group and the CHBCD+AKI group (P<0.05). The hepatic encephalopathy rate, PT, TBIL, Scr, BUN, Cys-C, Child-Pugh grade C ratio, MELD score, and LSM in the CHBCD+AKI group were significantly higher than those in the CHBCD group (P<0.05), and Alb was significantly lower than that in the CHBCD group (P<0.05). In the CHBCD+AKI group, hepatic encephalopathy, PT, TBIL, Cys-C, Child-Pugh grade, MELD score, and LSM were positively correlated with Scr and BUN (all rs>0, P<0.05), and negatively correlated with Alb (all rs<0, P<0.05). Scr≥467.2μmol/L, BUN≥11.5mmol/L, Cys-C≥2.7mg/L, Child-Pugh grade C, MELD score≥15.4, and LSM≥26.5kPa were independent risk factors for acute kidney injury secondary to decompensated liver cirrhosis due to chronic hepatitis B (P<0.05). The sensitivity, specificity, and AUC of BUN, Cys-C, MELD score, and LSM in predicting acute kidney injury secondary to decompensated liver cirrhosis due to chronic hepatitis B were higher than those of Scr and Child-Pugh grade. The median survival of patients in the CHBCD+AKI group was significantly lower than that in the CHBCD group (median survival 17.3±3.5 months vs 26.5±4.7 months, Log Rank=17.248, P<0.001). Conclusion Scr, BUN, Cys-C, Child-Pugh grade, MELD score and LSM are independent risk factors for acute kidney injury secondary to decompensated liver cirrhosis due to chronic hepatitis B, and the survival of patients with acute kidney injury secondary to decompensated liver cirrhosis due to chronic hepatitis B is significantly reduced.

  Key words: Chronic hepatitis B; Liver cirrhosis; Decompensated stage; Acute kidney injury; Risk factors

  提交时间：2024-09-25

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• 序号	提交日期	编号	操作
  1	2024-09-18	bmr.202409.00056V1	下载

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