低氯血症对肝硬化2或3级腹水患者短期预后的影响OA
Effect of hypochloremia on short-term prognosis in patients with cirrhosis and grade 2 or 3 ascites
目的 探讨低氯血症对肝硬化2或3级腹水患者短期不良预后的影响.方法 回顾性选取2022年10月1日-2023年9月30日因肝硬化2或3级腹水住院的119例患者为研究对象.采用X-tile软件计算血清氯离子(Cl⁻)水平的最佳截断值,以入院后1年的临床不良结局,即死亡、进一步失代偿、因腹水再住院,作为3个独立的研究终点,采用多因素Cox回归、Kaplan-Meier曲线和时间依赖的ROC曲线等分析评价血清Cl⁻的预测价值,并进行合并或未合并肝恶性肿瘤(PHC)的亚组分析.结果 血清Cl⁻预测肝硬化2或3级腹水患者1年不良临床结局的最佳截断值是104.9 mmol/L.多因素Cox回归分析显示,血清Cl⁻<104.9 mmol/L是肝硬化2或3级腹水患者1年死亡(HR=2.351,95%CI 1.390～3.977)、进一步失代偿(HR=3.267,95%CI 1.682～6.344)及因腹水再住院(HR=2.009,95%CI 1.013～3.991)的独立危险因素(P<0.05).Kaplan-Meier曲线分析显示,上述不良预后的累积发生风险在血清Cl⁻<104.9 mmol/L的患者中明显高于血清Cl⁻≥104.9 mmol/L的患者(Log-rank P<0.05).时间依赖的ROC曲线及Delong检验显示,血清Cl⁻水平预测上述不良预后的效能与传统Child-Pugh评分和终末期肝病模型(MELD)评分相当(P>0.05).亚组分析显示,无论合并或未合并PHC患者,Cl⁻<104.9 mmol/L对死亡结局均有较好的预测价值,但对于进一步失代偿结局的预测仅适用于未合并PHC的患者,对于因腹水再住院的风险预测则在两个亚组中均不适用.结论 低水平血清Cl⁻(<104.9 mmol/L)是肝硬化2或3级腹水患者短期不良预后的独立危险因素,纠正低氯血症可能是改善患者预后的重要手段之一.
Objective To explore the impact of hypochloremia on the short-term adverse prognosis in patients with liver cirrhosis and grade 2 or 3 ascites.Methods A total of 119 hospitalized patients diagnosed with liver cirrhosis complicated with grade 2 or 3 ascites were retrospectively enrolled from October 1,2022 to September 30,2023.The X-tile software was used to determine the optimal cut-off value of serum Cl-.The primary adverse clinical outcomes included 1-year all-cause mortality,progressive decompensation,and/or readmission due to recurrent ascites.Cox regression analysis,Kaplan-Meier survival curves,and time-dependent receiver operating characteristic(ROC)curves were applied to evaluate the predictive value of serum Cl-.Subgroup analyses were further performed based on the presence or absence of primary hepatic carcinoma(PHC).Results The optimal cut-off value of serum Cl-for predicting 1-year adverse clinical outcomes in these patients was determined as 104.9 mmol/L via X-tile analysis.Multivariate Cox regression analysis showed that serum Cl-<104.9 mmol/L was an independent risk factor for 1-year mortality(HR=2.351,95%CI 1.390-3.977),progressive decompensation(HR=3.267,95%CI 1.682-6.344),and ascites-related readmission(HR=2.009,95%CI 1.013-3.991)(P<0.05).Kaplan-Meier curves revealed that the cumulative risks of the above adverse events were significantly higher in patients with serum Cl-<104.9 mmol/L than in those with serum Cl-≥104.9 mmol/L(Log-rank P<0.05).Time-dependent ROC curves and Delong tests indicated that the predictive efficacy of serum Cl-was comparable to that of the traditional Child-Pugh score and Model for End-Stage Liver Disease(MELD)score(P>0.05).Subgroup analyses demonstrated that serum Cl-<104.9 mmol/L had a favorable predictive value for mortality in both subgroups with or without PHC.However,its predictive effect on progressive decompensation was only significant in patients without PHC,and no obvious predictive difference was observed in ascites-related readmission between the two subgroups.Conclusion Lower serum Cl-level(<104.9 mmol/L)is an independent risk factor for short-term adverse prognosis in patients with liver cirrhosis and grade 2 or 3 ascites,and correction of hypochloremia may serve as a crucial strategy to improve clinical outcomes of such patients.
王晴晴;丁洁;李海雯;刘怀鄂;耿鹏;李生浩;杨永锐
昆明市第三人民医院/云南省传染性疾病临床医学中心肝病综合科,云南 昆明 650041昆明市第三人民医院/云南省传染性疾病临床医学中心肝病综合科,云南 昆明 650041昆明市第三人民医院/云南省传染性疾病临床医学中心科教学术部,云南 昆明 650041昆明医科大学第一附属医院老年消化科,云南 昆明 650031昆明市第三人民医院/云南省传染性疾病临床医学中心医学影像科,云南 昆明 650041昆明市第三人民医院/云南省传染性疾病临床医学中心肝病综合科,云南 昆明 650041昆明市第三人民医院/云南省传染性疾病临床医学中心科教学术部,云南 昆明 650041
医药卫生
低氯血症肝硬化腹水不良预后
hypochloremialiver cirrhosisascitesadverse prognosis
《解放军医学杂志》 2026 (8)
1195-1205,11
This work was supported by the National Natural Science Foundation of China(82260408),the Science Research Fund of Education Department of Yunnan Province(2024J0863),the Specialized Union Program between Science and Technology Department and Local Universities of Yunnan Province(202501BA070001-057),the High-Level Health and Medical Technical Talent of Yunnan Province(D-2025037),the Social Development and Science and Technology Benefiting Public Program of Kunming STB(2025-NS-029),the 535 Talent Project of First Affiliated Hospital of Kunming Medical University(2023535D14),and the Health Research Project of Kunming Municipal Health Commission(2025-02-04-001,2025-03-03-005,2025-03-08-020) 国家自然科学基金(82260408)云南省教育厅科学研究基金项目(2024J0863)云南省科技厅-地方高校联合专项(202501BA070001-057)云南省高层次卫生健康技术人才培养专项(D-2025037)昆明市科技局社会发展与科技惠民计划项目(2025-NS-029)昆明医科大学第一附属医院"535人才工程"(2023535D14)昆明市卫健委卫生科研项目(2025-02-04-001,2025-03-03-005,2025-03-08-020)
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