慢加急性肝衰竭患者非生物型人工肝支持系统治疗后总胆红素清除率与90天短期预后关系

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中图分类号：R575 文献标志码：A 文章编号：2097-7174（2025）10-0966-06

DOI：10.3969/j.issn.2097-7174.2025.10.008

Abstract：Objective：To explore therelationship between the total bilirubin clearancerate（TBCR）of patients with acute-on-chronic liverfailure（ACLF）aftertreatment with non-biologicalartificial liversupportsystem（ALSS）andtheir short-term prognosis within90 days.Methods：Atotal of90 patientswith ACLF treated withthe non-biological ALSS centeredonPDFatTheFifthPeople'sHospitalofGanzhoufromAugust2021toDecember2023wereincluded inthe study.Relevant clinical informationof thepatients wascollected.Therelationship between TBCRandthe prognosisof ACLF wasanalyzed byrestrictivecubic spline analysis.The Cox regresion model wasused to analyze the influencing factorsrelated tothe9O-dayprognosisof ACLF patients treatedwith non-biological ALSS.Thereceiver operating characteristic（ROC）curve was used to evaluate theeficacy of prognostic predictive indicators.Results：The 90-day transplantation-free survival rate of 9O patients was 56.67% .Compared with patientswho died within 9O days，those who survived without transplantation within 9O days had a milder disease severity（ P<0.001 ），fewer treatments for nonbiological ALSS（ P<0.001 ），and ahigher averageTBCR（ P=0.010， .Coxregression analysis showed that MELD score （204号 ⌊HR（95%CI）：1.10（1.04-1.15） ， P<0.001 ， TBCR⌊HR（95%CI）：0.13（0.04-0.43） ，P=0.001] and the number of treatments for non-biological ALSS ⌊HR（95%CI）：1.43（1.09-1.88） ，P=0.010] was an independent influencing factorforpredictingporshort-termprognosis.RestrictedcubicsplineanalysisshowedthatTBCRwaspositivelycorrelated with transplantation-free survival rate ⌊HR（95%CI）：0.23（0.08–0.67） ，P=O.OO7]. The Area under the ROC curve （AUC） （95 %CI ）of TBCR in predicting 90-day transplantation-free survival was 0.658（O.543-0.772）（P=0.011），and the sensitivity and specificity were 62. 7% and 66.7% ，respectively.Stratified analysis of TBCR showed that compared with ACLF patients with TBCR<42. 6% ，ACLF patients with TBCR≥42. 6% had a higher 9O-day survival rate （P=O.006）. Conclusion;Among patients whoreceivednon-biological ALS treatment，TBCR waspositivelycorrelated withthe90-day short-term prognosis of ACLF. Therefore，it can be used as a prognostic biomarker for ACLF.

Key Words：Liverfailure；Artificial liver；Prognostic prediction；Total bilirubin clearance rate

慢加急性肝衰竭（Acute-on-chronic liver failure，ACLF）是一种进展性疾病，可导致慢性肝病患者病情迅速恶化，短期死亡率高达 50%～90%[1.2] 。（剩余6791字）