有效肝血流量对慢加急性肝功能衰竭短期预后评估  

Assessment on short- term prognosis value of noninvasive effective hepatic blood flow in patients with acute on chronic liver failure

作　　者：吴婧[1] 倪鎏达[2] 张懿[1] 江甫柱[1,2] 孙双双[1] 程明亮[1] 傅青春[2] 陈成伟[2] 

机构地区：[1]贵阳医学院,550001 [2] 解放军第八五医院南京军区肝病中心

出　　处：《肝脏》2015年第4期291-294,共4页Chinese Hepatology

基　　金：吴阶平医学基金会肝病医学部肝功能评估研究基金(LDWMFPJ2011D001);南京军区创新课题基金(10MB002)

摘　　要：目的：探索有效肝血流量（EHBF）对慢加急性肝功能衰竭（ACLF）短期预后评估价值。方法回顾性分析63例 ACLF 患者的临床资料，以3个月内死亡为终点，在确诊 ACLF 后24 h 内采用脉搏染料光密度法测定 EHBF、ICGR15值，同时记录24 h 内各项临床化验指标。结果63例患者中21例死亡；EHBF 与 ALT、TBil、DBil 、Alb 、GGT有较好的相关性（r＝－0.26、－0.37、－0.34、－0.29、0.48）；提示 EHBF 是影响 ACLF 预后的主要相关因素之一，EHBF ROC 曲线下面积为0.669（95％ CI ：0.539～0.782），与 MELD 评分0.711（95％ CI ：0.510～0.758，P ＝0.07）相比无显著差异，而明显优于 CTP 分级的0.581（95％ CI ：0.495～0.738，P ＜0.01）和 KCH 标准0.554（95％ CI ：0.458～0.722，P ＜0.01）；EHBF ROC 曲线截断值对预后预测也有一定价值，当 EHBF≤0.221时病死率为44.7％，EHBF＞0.221时为16％（χ2＝5.6，P ＝0.018）。结论 EHBF 能较准确预测 ACLF 患者的短期预后。Objective To investigate short-term prognostic value of noninvasive effective hepatic blood flow （EHBF） in patients with acute-on-chro2nic live failure （ACLF）.Methods Clinical data of 63 patients diagnosed with acute on chronic liver failure was retrospectively analyzed.End point was death within three months after diagnosed.EHBF and indocyanine green retention rate at 15 min （ICGR15）were performed within 24 hours after diagnosis.Meanwhile,clinical biochemical indicators were collected.Results In total 63 patients,21 cases died （33.3%）,42 cases survived（66.7%）;EHBF had significant correlation with ALT ,TBIL,DBIL,ALB,and GGT （r = - 0.26,- 0.37,- 0.34,- 0.29,0.48, respectively）;prognostic factors analysis showed that effective hepatic blood flow was one of main factors affecting prognosis of ACLF.Area under the curve generated by ROC curves was 0.669 （95% CI 0.539,0.782）for EHBF,0.711 （95% CI 0.510,0.785;P =0.07 ）for MELD,there was no significant difference between them.Both EHBF and MELD were significantly more superior than CTP grade （AUC=0.581 ,95% CI 0.459,0.738;P ＆lt;0.05 ）or KCH criteria （AUC=0.554,95% CI 0.458,0.722;P ＆lt;0.05 ）,respectively.The cut-off value of EHBF was 0.221 .The mortality rate was 44.7% when EHBF was less than 0.221 ,while the mortality rate was 16% when EHBF was higher than 0.221 （χ2 =5.6, P =0.018）.Conclusion EHBF could accurately predict short-term prognosis of patients with ACLF.

关 键 词：慢加急性肝功能衰竭 有效肝血流量 短期预后 

分 类 号：R575.3[医药卫生—消化系统]