传染病信息

目的 探究预后营养指数对人工肝治疗乙型肝炎相关慢加急性肝衰竭（hepatitis B virus related acute-onchronic liver failure, HBV-ACLF）患者的预后评估价值。方法 选取2022年1月至2023年12月在晋城大医院接受人工肝治疗的HBV-ACLF患者123例作为研究对象。所有患者完成3个月随访后，根据预后转归分为预后良好组与预后不良组。对比2组患者基线资料、实验室相关指标水平变化（基线、入院第3 d、入院第7 d、入院第14 d）及预后营养指数、预后营养指数1（入院第7 d预后营养指数-基线预后营养指数）、预后营养指数2（入院第14 d预后营养指数-基线预后营养指数）；运用多因素Logistic分析筛选影响行人工肝治疗的HBV-ACLF患者预后的独立危险因素；利用受试者工作特征（receiver operating characteristic, ROC）曲线评估预后营养指数（基线值及动态变化值）及其联合多因素指标对人工肝治疗HBV-ACLF患者预后的预测效能。结果 与预后不良组相比，预后良好组患者白细胞计数、中性粒细胞计数、肝疾病严重程度评分系统（Child-Turcotte-Pugh, CTP）评分、总胆红素、白细胞介素6(interleukin-6, IL-6)水平、人工肝治疗次数更低；而白蛋白、基线预后营养指数、血红蛋白（hemoglobin, Hb）、入院第7 d预后营养指数、淋巴细胞计数、入院第14 d预后营养指数、凝血酶原活动度、预后营养指数2、血清钠更高，且差异均具有统计学意义（P均<0.05）。多因素Logistic回归分析结果显示，影响人工肝治疗HBV-ACLF患者预后不良的独立危险因素包括预后营养指数2、血清钠、Hb、淋巴细胞计数、白蛋白、凝血酶原活动度、中性粒细胞计数、总胆红素、IL-6、白细胞计数、人工肝治疗次数、CTP评分、基线预后营养指数。ROC曲线结果显示：预后营养指数2的准确度、灵敏度均高于基线预后营养指数及各项指标，且总胆红素、Hb、凝血酶原活动度、中性粒细胞计数、白细胞计数、白蛋白、淋巴细胞计数、血清钠、CTP评分、IL-6、基线PNI、PNI2、人工肝治疗次数联合检测灵敏度及准确度均高于各单项检测指标。结论 预后营养指数是评估人工肝治疗HBV-ACLF患者预后的有效指标，且总胆红素、Hb、凝血酶原活动度、中性粒细胞计数、白细胞计数、白蛋白、淋巴细胞计数、血清钠、CTP评分、IL-6、基线PNI、PNI2、人工肝治疗次数联合检测的预测价值更高。

Objective To explore the prognostic value of prognostic nutritional index(PNI) in evaluating outcomes of patients with hepatitis B virus related acute-on-chronic liver failure(HBV-ACLF) treated with artificial liver support system. Methods A total of 123 patients with HBV-ACLF who received artificial liver treatment in Jincheng Major Hospital from January 2022 to December 2023 were enrolled. After 3-month follow-up, they were divided into the good prognosis group and the poor prognosis group according to their outcomes. Baseline data of the two groups of patients, changes in the levels of laboratory-related indicators(at baseline, 3rd, 7th, 14th day after admission), as well as PNI, PNI1(PNI at 7th day after admission minus baseline PNI), and PNI2(PNI at 14th day after admission minus baseline PNI) were compared. Multivariate Logistic regression analysis was used to identify independent risk factors for poor prognosis of HBV-ACLF patients treated with artificial liver support treatment; The Receiver operating characteristic(ROC) curve was used to evaluate the predictive efficacy of PNI(baseline value and dynamic change value) alone and in combination with other indicators for the prognosis of patients with HBV-ACLF treated with artificial liver. Results Compared with the poor prognosis group, patients in the good prognosis group had lower white blood cell counts, neutrophil counts, Child-Turcotte-Pugh(CTP) scores, total bilirubin, interleukin-6(IL-6) levels, and the number of artificial liver treatments; and higher albumin, baseline PNI, hemoglobin(Hb), PNI at 7th day after admission, lymphocyte count, PNI at 14th day after admission, prothrombin activity level, PNI2, and serum sodium(all P <0.05). Multivariate Logistic regression analysis showed that the factors affecting the poor prognosis of HBV-ACLF patients treated with artificial liver included PNI2, serum sodium, Hb, lymphocyte count, albumin, prothrombin activity, neutrophil count, total bilirubin, IL-6, leukocyte count, the number of artificial liver treatments, CTP scores, and the baseline PNI. ROC curve analysis showed that the accuracy and sensitivity of PNI2 was higher than that of baseline PNI and other single indicators, and the sensitivity and accuracy of the combined test of total bilirubin, Hb, prothrombin activity, neutrophil count, white blood cell count, albumin, lymphocyte count, serum sodium, CTP score, IL-6, baseline PNI, PNI2, and the number of artificial liver treatments was higher than that of any single indicator. Conclusion PNI is an effective indicator for evaluating the prognosis of patients with HBV-ACLF treated with artificial liver, and the combined detection of total bilirubin, Hb, prothrombin activity, neutrophil count, white blood cell count, albumin, lymphocyte count, serum sodium, CTP score, IL-6, baseline PNI, PNI2 and the number of artificial liver treatments has higher predictive value.