抗凝血酶III活性对急慢性肝衰竭患者预后的预测价值

中华传染病杂志 Pub Date : 2020-02-15 DOI:10.3760/CMA.J.ISSN.1000-6680.2020.02.010

Xueshi Zhou, Y. Ye, Ya-Ni Mao, Tingting Su, Hejuan Du, Xiaoye Guo, Lingxiao Zhou, Ying Zhang, Lihua Huang, Yuanwang Qiu

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The AT-Ⅲ activity values at admission, week two, week four, and week eight of hospitalization were recorded, and the occurrences of fecal occult blood and femoral vein thrombosis were also recorded. The measurement data were compared by t test, analysis of variance, or rank sum test, and the categorical data were compared by chi-square test. The risk factors affecting the survival of ACLF patients were analyzed by Cox regression. The survival analysis was performed using the Kaplan-Meier method. \n \n \nResults \nAt the end of 90-day follow-up of 130 patients, 56 patients died, 20 patients (15.38%) were fecal occult blood positive and 15 (11.54%) had femoral vein thrombosis. The baseline AT-Ⅲ activity in the death group was lower than that in the survival group ((17.89±13.68)% vs (36.03±11.96)%), and the difference was statistically significant (t=-8.045, P 0.05). 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引用次数: 0

摘要

目的分析抗凝血酶Ⅲ(AT-Ⅲ)活性与急性慢性肝衰竭(ACLF)患者生存、出血及血栓形成并发症的关系，探讨AT-Ⅲ活性对ACLF患者预后的预测价值。方法回顾性收集无锡市第五人民医院2013年1月1日至2019年4月1日收治的130例ACLF住院患者的临床资料。检测肝功能、国际标准化比值(INR)、90天生存率。记录患者入院、住院第2周、第4周、第8周AT-Ⅲ活性值，并记录粪便隐血和股静脉血栓的发生情况。计量资料比较采用t检验、方差分析或秩和检验，分类资料比较采用卡方检验。采用Cox回归分析影响ACLF患者生存的危险因素。生存率分析采用Kaplan-Meier法。结果130例患者随访90 d，死亡56例，粪便隐血阳性20例(15.38%)，股静脉血栓形成15例(11.54%)。死亡组AT-Ⅲ基线活性低于生存组((17.89±13.68)% vs(36.03±11.96)%)，差异有统计学意义(t=-8.045, P 0.05)。Cox回归分析提示INR(优势比(OR)=1.364, 95%可信区间(CI) 1.078 ~ 1.726, P=0.010)和AT-Ⅲ活性(OR=0.930, 95%CI 0.906 ~ 0.954, P<0.01)是影响ACLF患者生存的独立因素。预测患者90天生存结局的AT-Ⅲ活性受体操作者特征曲线下面积为0.706 (95%CI 0.773 ~ 0.952, P<0.01)，临界值为25%。AT-Ⅲ活性≥25%的患者生存率高于AT-Ⅲ活性<25%的患者(χ2=58.20, P<0.01)。结论AT-Ⅲ活性与ACLF患者粪便隐血阳性及股静脉血栓形成有关。AT-Ⅲ活性是预测ACLF患者预后的独立影响因素。AT-Ⅲ活性低于25%的患者死亡率较高。关键词:抗凝血酶Ⅲ;活性;肝功能衰竭，急性伴慢性;预后;预测

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Prediction value of antithrombin III activity in the prognosis of patients with acute-on-chronic liver failure

Objective To analyze the relationship between antithrombin Ⅲ(AT-Ⅲ) activity and survival, bleeding and thrombosis complications in patients with acute-on-chronic liver failure (ACLF), and to explore the prediction value of AT-Ⅲ activity in the prognosis of ACLF patients. Methods The clinical data of 130 hospitalized patients with ACLF were retrospectively collected in Wuxi No.5 People′s Hospital from January 1, 2013 to April 1, 2019. The liver function, international normalized ratio (INR), and 90-day survival rate were detected. The AT-Ⅲ activity values at admission, week two, week four, and week eight of hospitalization were recorded, and the occurrences of fecal occult blood and femoral vein thrombosis were also recorded. The measurement data were compared by t test, analysis of variance, or rank sum test, and the categorical data were compared by chi-square test. The risk factors affecting the survival of ACLF patients were analyzed by Cox regression. The survival analysis was performed using the Kaplan-Meier method. Results At the end of 90-day follow-up of 130 patients, 56 patients died, 20 patients (15.38%) were fecal occult blood positive and 15 (11.54%) had femoral vein thrombosis. The baseline AT-Ⅲ activity in the death group was lower than that in the survival group ((17.89±13.68)% vs (36.03±11.96)%), and the difference was statistically significant (t=-8.045, P 0.05). The Cox regression analysis suggested INR (odds ratio (OR)=1.364, 95% confidence interval (CI) 1.078-1.726, P=0.010) and AT-Ⅲ activity (OR=0.930, 95%CI 0.906-0.954, P<0.01) were the independent factors affecting the survival of patients with ACLF. The area under the receiver operator characteristic curve of the AT-Ⅲ activity for predicting 90-day survival outcome of the patient was 0.706 (95%CI 0.773-0.952, P<0.01), and the cut-off value was 25%. Patients with AT-Ⅲ activity ≥ 25% had a higher survival rate than those with AT-Ⅲ activity <25% (χ2=58.20, P<0.01). Conclusions AT-Ⅲ activity is associated with fecal occult blood positive and femoral vein thrombosis in ACLF patients. The AT-Ⅲ activity is an independent influencing factor for predicting the prognosis of ACLF patients. Patients with AT-Ⅲ activity less than 25% have the higher mortality rate. Key words: Antithrombin Ⅲ, activity; Liver failure, acute-on-chronic; Prognosis; Forecasting

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中华传染病杂志

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5280

期刊介绍： The Chinese Journal of Infectious Diseases was founded in February 1983. It is an academic journal on infectious diseases supervised by the China Association for Science and Technology, sponsored by the Chinese Medical Association, and hosted by the Shanghai Medical Association. The journal targets infectious disease physicians as its main readers, taking into account physicians of other interdisciplinary disciplines, and timely reports on leading scientific research results and clinical diagnosis and treatment experience in the field of infectious diseases, as well as basic theoretical research that has a guiding role in the clinical practice of infectious diseases and is closely integrated with the actual clinical practice of infectious diseases. Columns include reviews (including editor-in-chief reviews), expert lectures, consensus and guidelines (including interpretations), monographs, short monographs, academic debates, epidemic news, international dynamics, case reports, reviews, lectures, meeting minutes, etc.