三种评价指标在肝衰竭患者人工肝治疗短期预后中的作用  

Predictive values of three indexes on short-term prognosis in patients with liver failure treated by artificial liver support system

作　　者：周健[1] 叶俊茂[1] 王雪丽[1] 陈红[1] 徐敏芬[1] 黄建荣[2] 

机构地区：[1]宁波市第二医院重症肝炎科,315010 [2]浙江大学医学院附属第一医院传染病诊治国家重点实验室,杭州310003

出　　处：《中华危重症医学杂志（电子版）》2011年第1期12-16,共5页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：艾滋病和病毒性肝炎等重大传染病防治科技重大专项(2008ZX10002-005)

摘　　要：目的比较吲哚氰绿15分钟滞留率(ICGR15)、终末期肝病模型(MELD)评分与凝血酶原时间(PT)对肝衰竭患者短期预后的预测能力,探讨人工肝支持系统在肝衰竭治疗中的效果。方法记录83例肝衰竭患者血浆置换治疗前的ICGR15、MELD和PT值,应用受试者工作特征曲线(ROC)曲线下面积评价ICGR15、MELD和PT的预测能力,根据出院时临床转归,将治愈或好转者归入有效组(54例),死亡或未愈自动出院者归入无效组(29例),进行疗效评价。结果①亚急性肝衰竭组早期治愈9例,中期治愈5例,差异无统计学意义(P>0.05)。慢加亚急性肝衰竭组早期好转15例,中期好转24,晚期无好转,好转情况早期好于中期(P<0.05)。亚急性与慢加亚急性肝衰竭组早期间及中期间比较,疗效差异无统计学意义(P均>0.05)。②有效组和无效组ICGR15、MELD分值和PT分别为(48.333±11.482)%vs(54.817±6.514)%(t=3.281,P<0.05),(28.11±4.19)vs(33.52±4.09)(t=5.655,P<0.05)和(26.028±6.690)svs(38.300±13.405)s(t=4.63,P<0.05),差异均有统计学意义。③ICGR15、MELD评分和PT预测肝衰竭患者短期预后的ROC曲线下面积分别为0.712、0.852和0.801。95%可信区间分别为0.602～0.822,0.765～0.939和0.695～0.906,三者间比较,差异均无统计学意义(P均>0.05)。结论人工肝疗效与肝衰竭治疗时间的早晚密切相关。肝衰竭患者病情越重,ICGR15、MELD分值和PT越高。ICGR15、MELD评分和PT均能较好地预测肝衰竭的预后。Objective To evaluate the predictive values of indocyanine green retention rate at 15 min （ICGR15）, model for end-stage liver disease （MELD） score and prothrombin time （PT） on short-term prognosis in patients with liver failure, and study the role of artificial liver support system （ALSS） on liver failure disease. Methods ICGR15, MELD scores and PT were detected in 83 cases with liver failure before the therapy of plasma exchange. The areas under curve （AUC） of the ICGR15, MELD scores and PT were calulated and compared. The patients were divided into effective group （54 cases, cured or improved） and ineffective group （29 cases, died or uncured） according to clinical outcomes. Results Nine and 5 cases were cured in early and middle period of subacute liver failure （SALF） respectively, and no significant difference was found （P〉0.05）. Fifteen and 24 cases were improved in early and middle periods of subacute-on-chronic liver failure （ACLF）, respectively. The improvement condition in early period of ACLF was better than the middle period （P〈0.05）. There is no significant difference between the SALF group and ACLF group in the early and middle period （P〉0.05）. The ICGR15, MELD scores and PT in effective group and ineffective group were （48.333±11.482）% vs （54.817±6.514）%（t=3.281, P〈0.050）, （28.11±4.19） vs （33.52±4.09）（t=5.655,P〈0.05） and （26.028±6.690） s vs （38.300±13.405） s （t=4.63,P〈0.05）, respectively. The AUC of ICGR15, MELD scores and PT for the short-term prediction of prognosis was 0.712（95%CI 0.602～0.822）, 0.852（95%CI 0.765～0.939） and 0.801（95%CI 0.695～0.906）. There were no significant difference among them （all P〉0.05）. Conclusions The curative effect is closely related with the treatment time. The higher ICGR15, MELD scores and PT indicate the severer disease condition. ICGR15, MELD scoring system and PT can predict the short-term prognosis of liver failure.

关 键 词：肝功能衰竭 肝 人工 吲哚菁绿 终末期肝病模型 凝血酶原时间 预后 

分 类 号：R575.3[医药卫生—消化系统]