摘要
[目的]探究影响乙型病毒性肝炎相关性慢加急性肝衰竭(HBV-ACLF)90 d预后的危险因素,评估新评分模型的短期预测价值.[方法]纳入132例HBV-ACLF患者,依据患者病程90 d的临床转归分为生存组和死亡组,收集临床资料进行肝功能评分(CTP)、终末期肝病模型(MELD)、AARC评分.分析影响HBV-ACLF患者90 d病死率的独立危险因素.通过建立新的预测模型,并应用ROC曲线评价患者短期预后的价值,绘制K-M生存曲线分析并预测短期预后.[结果]生存组与死亡组间凝血酶原时间、凝血酶原活动度、AARC、MELD、D-二聚体、乳酸、总胆红素、直接胆红素比较均差异有统计学意义(P＜0.05).Logistics回归分析提示MELD评分[比值比(OR)=3.125,95％可信区间(95％CI):1.131～8.638,P=0.028)]、AARC 评分(OR=5.477,95％CI:1.990～15.071,P=0.001)、D-二聚体(OR=1.000,95％CI:1.000～1.001,P=0.014)是影响 HBV-ACLF 患者 90 d 死亡的独立危险因素,肝衰竭发生死亡风险随评分升高而增加.Cox回归模型建立新的预测模型.MELD、AARC、MELD-AARC三种评分模型的曲线下面积分别为0.718、0.816、0.818.MELD-AARC评分略优于MELD、AARC评分,均差异有统计学意义(P＜0.001).MELD-AARC评分≥9.79患者较MELD-AARC评分＜9.79患者病死率增高,差异有统计学意义(P＜0.001).[结论]HBV-ACLF患者MELD评分、AARC评分值及D-二聚体升高可预测90 d死亡风险的增加.3种评分系统均能较好地预测HBV-ACLF患者的短期预后,MELD-AARC评分模型准确性可.
Abstract
[Objective]To explore the risk factors that affect the short-term prognosis of chronic and acute liver failure associated with hepatitis B virus(HBV-ACLF),and valuate the short-term predictive val-ue of the new scoring model.[Methods]A total of 132 HBV-ACLF patients were enrolled in the study.Ac-cording to their clinical outcomes during hospitalization and 90 d after discharge,they were divided into sur-vival group and death group.Clinical data were collected for liver function score(CTP)and end-stage liver disease model(MELD).AARC scoring system,the score includes 5 indicators of total bilirubin,hepatic en-cephalopathy grade,INR,blood lactate and creatinine.After analyzing the independent risk factors that af-fect the 90 d mortality of HBV-ACLF patients with multivariate logical regression,a new predictive model was established through the Cox regression model,and the receiver operating characteristic curve was used to evaluate the value of the model for short-term prognosis,and the KM survival curve was used to analyze the patient's prognosis.[Results]There were statistical differences in PT,PT A,A ARC,MELD,D-dimer,lactic acid,total bilirubin,and direct bilirubin between the survival group and the death group of patients with liver failure(all P＜0.05).Logistics regression analysis indicated that MELD score(odds ratios[OR]=3.125,95％confidence interval[95％CI]:1.131-8.638,P=0.028),A ARC score(OR=5.477,95％CI:1.990-15.071,P=0.001),and D-dimer(OR=1.000,95％CI:1.000-1.001,P=0.014)were independent risk factors for the 90 d mortality of HBV-ACLF patients.As the score increases,the risk of death from liver failure also increased.Cox regression model established a new prediction model.MELD,AARC,MELD-AARC three scoring models under the curve area were 0.718,0.816,0.818.MELD-AARC was slightly better than MELD,AARC score,The values were all less than 0.001,and the differences were sta-tistically significant.The mortality of patients with MELD-AARC score≥9.79 was higher than that of patients with MELD-AARC score＜9.79,and the difference was statistically significant(P＜0.001).[Con-clusion]Elevated MELD score,AARC score,and D-dimer predicted an increased risk of death at 90 d in pa-tients with HBV-ACLF.The three scoring systems can better predict the short-term prognosis of HBV-ACLF patients,and the MELD-AARC scoring model is accurate.
NETL
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万方数据