中性粒细胞与淋巴细胞比值联合国际标准化比值对乙型肝炎病毒相关慢加急性肝衰竭患者短期预后的预测价值评估

doi:10.19871/j.cnki.xfcrbzz.2025.04.005

摘要/Abstract

摘要： 目的探讨中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio,NLR）、国际标准化比值（international normalized ratio,INR）在乙型肝炎病毒相关慢加急性肝衰竭（hepatitis B virus-related acute-on-chronic liver failure,HBV-ACLF）患者短期预后评估中的预测价值,以期为临床提供简便实用的早期评估工具。方法对2021年1月至2022年12月成都市公共卫生临床医疗中心肝病科收治的210例HBV-ACLF患者进行回顾性研究,根据确诊后28d的转归情况分为生存组（n=148）和死亡组（n=62）,比较两组临床特征及实验室指标差异,采用多因素Logistic回归分析HBV-ACLF患者治疗转归的危险因素。结果与生存组相比,死亡组的肝性脑病、消化道出血、腹水等并发症发生率显著升高,INR与NLR水平显著升高,差异均有统计学意义（P<0.05）。多因素Logistic回归分析显示,NLR、INR升高和肝性脑病是HBV-ACLF短期预后的独立危险因素。进一步按NLR和INR四分位数分组分析发现,NLR>6.73组与INR>2.45组HBV-ACLF患者的28d死亡率显著升高。在调整年龄、性别及并发症等混杂因素后,NLR与INR升高仍是HBV-ACLF患者短期死亡的独立预测指标。结论 NLR、INR升高和肝性脑病是HBV-ACLF患者短期预后的独立危险因素,NLR与INR可作为简便有效的早期死亡风险预测指标。

关键词: 中性粒细胞与淋巴细胞比值, 国际标准化比值, 乙型肝炎病毒, 慢加急性肝功能衰竭, 预后

Abstract: Objective To explore the predictive value of neutrophil-to-lymphocyte ratio (nlr) and international normalized ratio (INR) in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF),aiming to provide simple and practical early assessment indicators for clinical use. Method A retrospective study was conducted on 210 patients with HBV-ACLF who were admitted to the Department of Hepatology at Chengdu Public Health Clinical Medical Center from January 2021 to December 2022. Based on the 28-day follow-up outcomes, the patients were divided into the survival group (n=148) and non-survivor group (n=62). Clinical characteristics and laboratory parameters were compared between the two groups. Multivariate logistic regression analysis was performed to identify factors influencing treatment outcomes in HBV-ACLF patients. Result Compared to the survival group, the non-survival group exhibited significantly higher incidences of complications such as hepatic encephalopathy, gastrointestinal bleeding, and ascites, along with elevated levels of INR and NLR (P<0.05). Multivariate logistic regression analysis identified NLR, INR, and hepatic encephalopathy as independent risk factors influencing short-term prognosis in HBV-ACLF patients. Further analysis based on NLR and INR quartiles revealed that patients with NLR >6.73 and INR >2.45 had significantly increased 28-day mortality rates. Even after adjusting for confounding factors such as age, sex, and complications, NLR and INR remained independent predictors of short-term mortality in HBV-ACLF patients. Conclusion NLR,INR,and hepatic encephalopathy are independent risk factors for short-term prognosis in HBV-ACLF patients. NLR and INR can serve as simple and effective predictive indicators for assessing the early mortality risk in HBV-ACLF patients.

Key words: Neutrophil-to-lymphocyte ratio, International normalized ratio, Hepatitis B virus, Acute-on-chronic liver failure, Prognosis

中图分类号:

R575.3

朱丽, 王补云, 胡瑞晴, 吴蓓, 王丽, 曾义岚. 中性粒细胞与淋巴细胞比值联合国际标准化比值对乙型肝炎病毒相关慢加急性肝衰竭患者短期预后的预测价值评估[J]. 新发传染病电子杂志, 2025, 10(4): 27-33.

Zhu Li, Wang Buyun, Hu Ruiqing, Wu Bei, Wang Li, Zeng Yilan. The predictive value of neutrophil-to-lymphocyte ratio and international normalized ratio on short-term prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(4): 27-33.

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