CTP联合ABIC评分预测乙型肝炎相关性慢加急性肝衰竭患者短期预后的临床意义  

Clinical significance of CTP combined with ABIC score in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure

作　　者：曹丹[1] 李大江[1] 王颖[1] 张永辉[1] 陈立宇 王丽春[1] Cao Dan;Li Dajiang;Wang Ying;Zhang Yonghui;Chen Liyu;Wang Lichun(Center of Infectious Diseases,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院感染性疾病中心,成都610041

出　　处：《中华肝脏病杂志》2019年第2期118-122,共5页Chinese Journal of Hepatology

摘　　要：目的探讨影响乙型肝炎相关性慢加急性肝衰竭(HBV-ACLF)短期预后的危险因素,并建立新的评分模型预测患者短期预后。方法研究共纳入222例HBV-ACLF患者,根据其住院期间及出院后90 d的临床转归分为生存组和死亡组,分别收集临床资料进行肝功能评分(CTP)、终末期肝病模型(MELD)、白蛋白-胆红素(ALBI)、年龄-胆红素-白蛋白-肌酐(ABIC)评分,多因素logical回归法分析影响HBV-ACLF患者90 d病死率的独立危险因素后,通过Cox回归模型建立新的预测模型,应用受试者工作特征曲线评价模型对短期预后的价值,并用K-M生存曲线分析预测患者预后。结果CTP、ABIC评分是HBV-ACLF患者90 d病死率的独立危险因素,随着得分的增加,肝衰竭发生死亡的风险就会增加。Cox回归模型建立新的预测模型CTP-ABIC = 0.551×CTP + 0.297×ABIC,CTP、ABIC、CTP-ABIC三种评分模型的曲线下面积分别为0.878、0.829、0.927,CTP-ABIC评分优于CTP、ABIC评分,P值均< 0.001,差异均有统计学意义。CTP-ABIC评分≥9.08患者较CTP-ABIC评分< 9.08患者病死率增高,差异具有统计学意义(P < 0.001)。结论三种评分系统均能较好地预测HBV-ACLF患者的短期预后,CTP-ABIC评分模型准确性更高。ObjectiveTo investigate the risk factors affecting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF), and establish a new scoring model to predict the short-term prognosis of patients.MethodsThis study enrolled 222 patients with HBV-ACLF. According to their clinical outcomes during hospitalization and 90 days after discharge, they were divided into survival and death group. Clinical data were collected to calculate the Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), albumin-bilirubin (ALBI), and age-bilirubin-international normalized ratio-creatinine (ABIC) scores for prognosis. Multivariate logistic regression analysis was used to analyze the independent risk factors affecting 90-day mortality in HBV-ACLF patients. Cox regression model was used to establish a new prediction model. Area under the receiver operating characteristic curve was used to calculate short-term prognostic value of the models. K-M survival curve was used to predict the prognosis of patients.ResultsCTP and ABIC scores were independent risk factors for 90-day mortality in HBV-ACLF patients, and the risk of death from liver failure had increased with increase of score. Cox regression model established a new predictive model CTP-ABIC = 0.551 × CTP + 0.297 × ABIC. Area under the receiver operating characteristic curve of all three scoring models (CTP, ABIC and CTP-ABIC) were 0.878, 0.829, 0.927, respectively. CTP-ABIC score was superior to the CTP and ABIC score (P value < 0.001). Patients with CTP-ABIC score ≥9.08 had higher mortality rate than patients with CTP-ABIC score < 9.08, and the difference was statistically significant (P < 0.001).ConclusionAll three scoring systems can predict short-term prognosis in patients with HBV-ACLF, but the accuracy of CTP-ABIC is superior.

关 键 词：肝炎 乙型 预后 评分模型 乙型肝炎相关性慢加急性肝衰竭 

分 类 号：R575.3[医药卫生—消化系统] R512.62[医药卫生—内科学]