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山东大学学报 (医学版) ›› 2024, Vol. 62 ›› Issue (3): 61-69.doi: 10.6040/j.issn.1671-7554.0.2024.0057

• 临床医学 • 上一篇    下一篇

单核细胞与淋巴细胞比值动态变化对慢加急性乙型肝炎肝衰竭预后的诊断价值

杨雪彦1,2,吴寅平1,2,吕丽3,赵泽华1,2,马行宇1,2,李凤彩1,2,王凯1,2,范玉琛1,2   

  1. 1.山东大学齐鲁医院肝病科, 山东 济南 250012;2.山东大学肝病研究所, 山东 济南 250012;3.山东大学齐鲁医院预约随访科, 山东 济南 250012
  • 发布日期:2024-05-06
  • 通讯作者: 范玉琛. E-mail:fanyuchen@sdu.edu.cn
  • 基金资助:
    国家自然科学基金(82270631);山东大学临床研究中心急危重症重点专项(2021SDUCRCB006)

Diagnostic value of dynamic changes of monocyte-to-lymphocyte ratio in acute-on-chronic hepatitis B liver failure

YANG Xueyan1,2, WU Yinping1,2, LYU Li3, ZHAO Zehua1,2, MA Hangyu1,2, LI Fengcai1,2, WANG Kai1,2, FAN Yuchen1,2   

  1. 1. Department of Hepatology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China;
    2. Institute of Hepatology, Shandong University, Jinan 250012, Shandong, China;
    3. Department of Outpatient and Follow Up Center, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
  • Published:2024-05-06

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摘要： 目的 研究单核细胞与淋巴细胞比值(monocyte/lymphocyte ratio, MLR)动态变化对慢加急性乙型肝炎肝衰竭(acute-on-chronic hepatitis B liver failure, ACHBLF)患者临床预后的诊断价值。 方法 回顾性纳入2010年1月至2023年7月在山东大学齐鲁医院肝病科住院的ACHBLF患者,平滑曲线拟合与阈值效应分析MLR值与患者30 d死亡风险的非线性关系,Logistic回归分析和Boruta算法评估患者30 d预后的风险因素,受试者工作特征曲线(receiver operating characteristic curve, ROC)评估MLR的诊断价值,Bootstrap法验证MLR的诊断价值。 结果 共纳入ACHBLF患者243例,其中98例患者在30 d内死亡。入院第8天MLR值是患者30 d预后的独立风险因素(OR=1.33, 95%CI:1.01~1.75, P=0.044),与30 d死亡风险呈非线性关系,入院第8天MLR值>1的患者死亡风险高于第8天MLR值≤1的患者(P<0.001)。入院第8天MLR值联合终末期肝病模型(model for end-stage liver disease, MELD)评分诊断30 d患者死亡的ROC曲线下面积为0.775(95%CI: 0.69~0.86)。 结论 入院第8天MLR>1提示ACHBLF患者30 d的预后不良,动态监测MLR的变化有助于ACHBLF的临床诊疗。

关键词: 慢加急性乙型肝炎肝衰竭, 单核细胞与淋巴细胞比值, 预后, 风险因素

Abstract: Objective To explore the diagnostic value of dynamic changes of monocyte/lymphocyte ratio(MLR)in the prognosis of acute-on-chronic hepatitis B liver failure(ACHBLF). Methods The study involved ACHBLF patients from January 2010 to July 2023 in the Department of Hepatology, Qilu Hospital of Shandong University. Smooth curve fitting and threshold effect analysis were used to evaluate the nonlinear relationship between MLR and 30-day mortality of ACHBLF patients. Logistic regression analysis and the Boruta algorithm were used to assess risk factors for 30-day mortality. The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of MLR and the bootstrap method was used for internal validation. Results In this study, 98 of the 243 individuals died within 30 days after hospitalization. MLR on the 8th day was identified as an independent risk factor for 30-day mortality of ACHBLF patients(OR=1.33, 95%CI:1.01-1.75, P=0.044), which was reported to be nonlinearly associated with 30-day mortality. Patients with MLR >1 on the 8th day showed a higher risk of mortality than those with MLR≤1(P<0.001). ROC curve showed that combination of MLR on the 8th day and the model for end-stage liver disease(MELD)score presented the area under the ROC of 0.775(95%CI: 0.69-0.86). Conclusion MLR>1 on the 8th day predicts poor 30-day prognosis in ACHBLF patients, and monitoring the dynamic changes of MLR is essential for the treatment of ACHBLF.

Key words: Acute-on-chronic hepatitis B liver failure, Monocyte /lymphocyte ratio, Prognosis, Risk factor

中图分类号: 

  • R575.3
[1] Beech C, Liu C, Zhang X. Pathology of acute and acute-on-chronic liver failure[J]. Clin Liver Dis, 2023, 27(3): 581-593.
[2] Ngu NLY, Flanagan E, Bell S, et al. Acute-on-chronic liver failure: controversies and consensus[J]. World J Gastroenterol, 2023, 29(2): 232-240.
[3] Sarin SK, Choudhury A, Sharma MK, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver(APASL): an update[J]. Hepatol Int, 2019, 13(4): 353-390.
[4] Br VK, Sarin SK. Acute-on-chronic liver failure: terminology, mechanisms and management[J]. Clin Mol Hepatol, 2023, 29(3): 670-689.
[5] Bhatti TK, Singal AK, Kwo PY. Viral hepatitis and acute-on-chronic liver failure[J]. Clin Liver Dis, 2023, 27(3): 617-630.
[6] Sarin SK, Kedarisetty CK, Abbas Z, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver(APASL)2014[J]. Hepatol Int, 2014, 8(4): 453-471.
[7] Yao J, Liu T, Zhao Q, et al. Genetic landscape and immune mechanism of monocytes associated with the progression of acute-on-chronic liver failure[J]. Hepatol Int, 2023, 17(3): 676-688.
[8] Li J, Liang X, Jiang J, et al. PBMC transcriptomics identifies immune-metabolism disorder during the development of HBV-ACLF[J]. Gut, 2022, 71(1): 163-175.
[9] Luo J, Li J, Li P, et al. Acute-on-chronic liver failure: far to go-a review[J]. Crit Care, 2023, 27(1): 259.
[10] Zawiah M, Hayat Khan A, Abu Farha R, et al. Neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio, and platelet-lymphocyte ratio in stroke-associated pneumonia: a systematic review and meta-analysis[J]. Curr Med Res Opin, 2023, 39(3): 475-482.
[11] Cheng HR, Song JY, Zhang YN, et al. High monocyte-to-lymphocyte ratio is associated with stroke-associated pneumonia[J]. Front Neurol, 2020, 11: 575809. doi: 10.3389/fneur.2020.575809.
[12] Hu G, Liu G, Ma JY, et al. Lymphocyte-to-monocyte ratio in esophageal squamous cell carcinoma prognosis[J]. Clin Chim Acta, 2018, 486: 44-48. doi: 10.1016/j.cca.2018.07.029.
[13] Hu RJ, Ma JY, Hu G. Lymphocyte-to-monocyte ratio in pancreatic cancer: prognostic significance and meta-analysis[J]. Clin Chim Acta, 2018, 481: 142-146. doi: 10.1016/j.cca.2018.03.008.
[14] Kang Y, Zhu X, Lin Z, et al. Compare the diagnostic and prognostic value of MLR, NLR and PLR in CRC patients[J]. Clin Lab, 2021, 67(9). doi: 10.7754/Clin.Lab.2021.201130.
[15] Hua Y, Sun JY, Lou YX, et al. Monocyte-to-lymphocyte ratio predicts mortality and cardiovascular mortality in the general population[J]. Int J Cardiol, 2023, 379: 118-126. doi: 10.1016/j.ijcard.2023.03.016.
[16] Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance[J]. Hepatology, 2018, 67(4): 1560-1599.
[17] 中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2022年版)[J].中华肝脏病杂志, 2022, 30(12): 1309-1331. Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B(version 2022)[J]. Zhonghua Gan Zang Bing Za Zhi, 2022, 30(12): 1309-1331.
[18] Moreau R, Gao B, Papp M, et al. Acute-on-chronic liver failure: a distinct clinical syndrome[J]. J Hepatol, 2021, 75(Suppl 1): S27-S35. doi: 10.1016/j.jhep.2020.11.047.
[19] World Medical Association.World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects[J]. JAMA, 2013, 310(20): 2191-2194.
[20] Ferstl P, Trebicka J. Acute decompensation and acute-on-chronic liver failure[J]. Clin Liver Dis, 2021, 25(2): 419-430.
[21] Zhang Y, Tan W, Wang X, et al. Metabolic biomarkers significantly enhance the prediction of HBV-related ACLF occurrence and outcomes[J]. J Hepatol, 2023, 79(5): 1159-1171.
[22] Jalan R, Williams R. Acute-on-chronic liver failure: pathophysiological basis of therapeutic options[J]. Blood Purif, 2002, 20(3): 252-261.
[23] Jiang F, Lei J, Xiang J, et al. Monocyte-to-lymphocyte ratio: a potential novel predictor for acute kidney injury in the intensive care unit[J]. Ren Fail, 2022, 44(1): 1004-1011.
[24] Wang N, He S, Zheng Y, et al. The value of NLR versus MLR in the short-term prognostic assessment of HBV-related acute-on-chronic liver failure[J]. Int Immunopharmacol, 2023, 121: 110489. doi: 10.1016/j.intimp.2023.110489.
[25] Engelmann C, Zhang IW, Clària J. Mechanisms of immunity in acutely decompensated cirrhosis and acute-on-chronic liver failure[J]. Liver Int, 2023. doi: 10.1111/liv.15644.
[26] Cai J, Wang K, Han T, et al. Evaluation of prognostic values of inflammation-based makers in patients with HBV-related acute-on-chronic liver failure[J]. Medicine(Baltimore), 2018, 97(46): e13324. doi: 10.1097/MD.0000000000013324.
[27] Ruf A, Dirchwolf M, Freeman RB. From child-pugh to MELD score and beyond: taking a walk down memory lane[J]. Ann Hepatol, 2022, 27(1): 100535. doi: 10.1016/j.aohep.2021.100535.
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