乙型肝炎慢加急性肝衰竭严重度简易评分系统  

A simple scoring system to evaluate the severity of acute-on-chronic liver failure in hepatitis B

作　　者：厉新妍[1] 雷瑞祥[1] 柯伟民[1] 李学俊[1] 赖菁[1] 朱建芸[1] 高志良[1] 

机构地区：[1]中山大学附属第三医院感染病科,广州510630

出　　处：《中华医学杂志》2009年第47期3353-3355,共3页National Medical Journal of China

摘　　要：目的建立一种评价乙型肝炎慢加急悱肝衰竭严重性的客观、简便、敏感的评分系统。方法中山大学附属第三医院感染病科1998年1月至2008年3月409例乙型肝炎慢加急性肝衰竭患者，分为存活组194例和死亡组215例，分析患者的肝性脑病，血清肌酐，凝血酶原活动度，血清总胆红素，感染，肝脏大小，腹水液平等7个临床指标，按照它们的严重性分别给予0～4分的评分并累计总分。将409例患者随机分为两批，第1批309例，存活144例和死亡165例用于建立评分模型及确定诊断界点。第2批100例，存活50例和死亡50例用于验证。结果慢加急性肝衰竭严重性总评分在144例生存组为6．9±3．2，165例死亡组为15．8±4．0，两组间差异有统计学意义（P〈0．01）。ROC曲线下面积为0．953，其最佳临界值为9．5，相心的灵敏度为0．97，特异度为0．82。根据最佳临界值将第2批患者（存活组50例，死亡组50例）分两组，≥10分组预后差，病死率为87．5％（49／56）；≤9分组预后好，病死率为2．3％（1／44），两组比较差异有统计学意义（P〈0．01）。结论本评分系统用于评价乙型肝炎慢加急性肝衰竭严重性具有简易、敏感、客观的优点。Objective To establish an objective, simple and sensitive scoring system to evaluate the severity of acute-on-chronic liver failure in hepatitis B. Methods The clinical data of patients （ 194 survivals and 215 deaths） with acute-on-chronic liver failure in hepatitis B were collected and analyzed prospectively. 7 clinical indexes, including the hepatic encephalopathy, creatinine, prothrombln activity, serum total bilirubin, infection, the dimension of liver, the maximum depth of ascites, were scored objectively and simply from 0 to 4 points according to their severity. Then we calculated every patient＇s total score and divided the 409 patients into two groups ： the one was 309 patients and the other is 100 patients. The first group was to establish the severity scoring system and define the cut-off-point, the second group was to test the severity scoring system. Results The total score of the 144 patients in the survival group was 6. 9 ± 3.2, 165 patients in the dead group was 15.8 ± 4.0, respectively. There were significant differences （P 〈 0. 01 ） between the two groups. The area under ROC curve was 0. 953. The cut-off-point is 9.5. The sensitivity was 0. 97,the specificity was 0. 82. The second group patients＇ total score were divided into two groups：the one is t≥10 score and the other is ≤9 score. The prognosis of the first group was much worse than the second group, it＇s mortality rate was 87.5%; the second was 2. 3%. There were significant differences between the two groups （ P 〈 0. 01 ）. Conclusions This scoring system was simple , sensitive and objective to evaluate the severity of acute-on-chronic liver failure in hepatitis B.

关 键 词：乙型肝炎 肝衰竭 严重性评分 

分 类 号：R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学]