天冬氨酸转氨酶与丙氨酸氨基转移酶比值和Child Pugh评分对肝硬化预后的评估  

Prognostic ability of AST/ALT ratio and Child Pugh score in patients with hepatitis B liver cirrhosis

作　　者：何益[1] 熊伍军[1] 

机构地区：[1]同济大学附属东方医院消化内科,上海200120

出　　处：《中国中西医结合消化杂志》2005年第1期28-30,共3页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

摘　　要：[目的] 探讨天冬氨酸转氨酶(AST)/丙氨酸氨基转移酶(ALT)比值与 Child Pugh评分对慢性乙肝肝硬化患者短、中期预后评估的价值。[方法] 对173例肝硬化患者的生存率进行回顾性评估,随访1 a。计算每例患者入院当天的AST/ALT比值与Child Pugh评分,以受试者特征曲线(ROC)下的面积衡量两者预测患者预后的能力,分析AST/ALT比值与Child Pugh评分的相关性。[结果] AST/ALT比值与 Child Pugh 评分呈显著相关( r=0 53,P<0 01)。随访3个月及1 a内分别有30例及50例患者死亡,死亡者AST/ALT比值与 Child Pugh 评分显著高于生存者(P<0 01)。依据 ROC曲线 AST/ALT比值截断值为 1 6,对患者 1 a预后判断的敏感性为55%,特异性为72%;Child Pugh 评分截断值为10,其敏感性76%,特异性 68%,联合应用两者敏感性和特异性可分别提高至85% 和76%。[结论] AST/ALT比值及Child Pugh评分均可有效地预测肝硬化患者的短期和中期预后,联合应用可提高其准确率。Objective] To assess the prognostic ability of the AST/ALT ratio in patients with hepatitis B liver cirrhosis, and to evaluate the relationship between the AST/ALT ratio and the Child Pugh score and to compare their prognostic ability. [Methods] The AST/ALT ratio and Child Pugh score of 173 patients with hepatitis B liver cirrhosis who had been followed up for at least 1 year were retrospectively calculated and correlated with the patients' 3 month and 1 year prognosis. Receiver operating characteristic curves were used to determine the AST/ALT ratio and the Child Pugh score cut offs with the best sensitivity (SS) and specificity (SP) in discriminating between patients who survived and those who died. [Results] AST/ALT ratios and Child Pugh score showed significant correlation (r = 0 53, P<0 01). In all, 17% (30/173) and 28% (50/173) of the patients had died after 3 months and 1 year of follow up, respectively. AST/ALT ratio and Child Pugh score were significantly higher among the patients who died during both 3 month and 1 yr follow up. An AST/ALT ratio cut off of 1.6 had 55% SS and 72% SP, whereas a Child Pugh score cut off of 10 had 76% SS and 68% SP in discriminating between patients who survived and those who died after 1 year. The combined assessment of the AST/ALT ratio and Child Pugh score had 85% SS and 76% SP. [Conclusion] In patients with hepatitis B liver cirrhosis, the AST/ALT ratio has prognostic capability that is not significantly different from that of Child Pugh score. Combined assessment of the two parameters increases the medium term prognostic accuracy.

关 键 词：肝硬化 天冬氨酸转氨酶/丙氨酸氨基转移酶比值 CHILD Pugh评分 预后 

分 类 号：R572.2[医药卫生—消化系统]