不同评分系统对乙肝相关慢加急性肝衰竭患者短期预后评估的比较  

Comparison of different scoring systems evaluating short-term prognosis of patients with hepatitis B associated acute hepatic failure

作　　者：刘磊[1] 王凤梅[1] 阚志超[1] 李岩[1] 肖时湘[1] 刘华[1] 李莹[1] 

机构地区：[1]天津市第三中心医院肝内科、天津市肝胆疾病研究所、天津市人工细胞重点实验室,300170

出　　处：《实用医学杂志》2014年第4期571-573,共3页The Journal of Practical Medicine

基　　金：天津市科委基金项目(编号:13JCYBJC22500)

摘　　要：目的:通过对几种不同评分系统比较,找出更适合乙肝相关慢加急性肝衰竭患者短期预后评估的方法。方法:将142例乙肝相关慢加急性肝衰竭患者根据其3个月后的存活及死亡情况,分为存活组(n=72)及病死组(n=70),分别计算CTP、MELD、ANN、SOFA、SMSVH、LRM等评分,行ROC曲线分析,计算曲线下面积,并进行比较。结果:ROC曲线下面积从大到小分别为ANN、SOFA、LRM、MELD、CTP、SMSVH,相应数值分别为0.92、0.89、0.89、0.87、0.78和0.69。ANN、SOFA、LRM、MELD的AUC之间比较差异无统计学意义(P>0.05),ANN、SOFA、LRM、MELD的AUC值>CTP、SMSVH,差异有统计学意义(P均<0.05),CTP的AUC值>SMSVH,差异有统计学意义(P<0.05)。结论 :ANN、SOFA、LRM、MELD较好;CTP稍差;SMSVH最差,不适用于乙肝相关慢加急性肝衰竭患者短期预后判断。ANN可能为最佳评分系统,但仍需大样本、多中心、动态的临床观察来证实。Objective To assessment short-term prognosis in patients with acute on chronic liver failure, several scoring systems were compared. Methods Two hundred and sixteen patients with acute on chronic liver failure were divided into survival group and death group according to the results of 90 days after admission.CTP, MELD, APACHE Ⅱ , SOFA and SMSVH score were calculated.After ROC curves were performed , the areas under the curves of these scoring systems were compared. Results The areas under the ROC curves of MELD, APACHE Ⅱ , SOFA, CTP and SMSVH were 0.88, 0.76, 0.89,0.79and 0.69,respectively. The areas under the curves of SOFA and MELD were larger than the APACHE Ⅱ , CTP and SMSVH （P 〈 0.05）. There was no difference between the SOFA and MELD （P 〉 0.05）. The area under the curve of CTP was larger than the APACHE Ⅱ , but there was no statistically significant difference （P 〉 0.05）. The area under the curve of SMSVH were less than 0.7. Conclusions The SOFA, MELD, CTP and APACHE Ⅱ can predict the short-term prognosis of acute on chronic liver failure. The SOFA and MELD are the best scoring systems.CTP, APACHE Ⅱ are better than SMSVH. SMSVH fail to predict the prognosis of acute on chronic liver failure.

关 键 词：评分系统 乙型肝炎 慢加急性肝衰竭 预后 受试者工作特征曲线 曲线下面积 

分 类 号：R575.3[医药卫生—消化系统]