MELD-EHBF模型建立及其对ACLF预后价值  

Establishment and evaluation of the MELD-EHBF model in ACLF patients

作　　者：吴婧[1] 倪鎏达[2] 江甫柱[1] 张懿[1] 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,550011 [2]解放军第八五医院南京军区肝病中心

出　　处：《肝脏》2015年第6期447-449,461,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(2010MB002)

摘　　要：目的建立无创有效肝血流量(EHBF)联合MELD模型,并评估其对慢加急性肝功能衰竭(ACLF)预后价值。方法 63例ACLF患者,确诊后24 h内采用PDD法测定EHBF、ICGR15值,同时记录24 h内各项临床实验室指标。以3个月内是否存活分死亡组(21例)和生存组(42例),采用Logistic回归分析建立MELD-EHBF模型,并研判其短期预后价值。结果将MELD评分与EHBF引入Logistic回归分析建立EHBF-MELD模型公式:ln(P1-P)=0.18×MELD-1.03×EHBF×102-3.29。COX回归模型比较MELD-EHBF、CTP、MELD、MELD-Na、MELD-ICG,显示MELD-EHBF模型最大似然卡方值最高和AIC值最小。MELD-EHBF ROC曲线下面积0.756(95%CI:0.632,0.856),临界值为51.77,敏感度47.6%,特异度为95.2%。以MELD-EHBF的ROC曲线下面积最大,明显优于CTP评分和KCH标准(P<0.05),亦优于MELD和EHBF(P<0.05)。结论 MELD-EHBF模型对ACLF患者短期预后有较好预测价值,优于单一的MELD和EHBF。Objective To assess the short‐term prognostic value of a MELD‐EHBF model established on noninvasively effective hepatic blood flow （EHBF） and the model for end‐stage liver disease （MELD） in patients with acute‐on‐chronic liver failure （ACLF） .Methods EHBF and indocyanine green retention at 15 minutes （ICGR15） of 63 patients were determined by PDD method within 24hrs after diagnosis of ACLF .At the same time ,the clinical and laboratory indexes of these patients were recorded .According to whether they survived 3 months after diagnosis ,the patients were divided into death group （n= 21） and survival group （42 cases） .Logistic regression analysis was used to establish the MELD‐EHBF .Results The MELD‐EHBF model constructed by logistic regression analysis was：ln （ P1- P）= 0 .18 × MELD‐1 .03 × EHBF × 10^2‐3 .29 .The results of COX regression model showed that MELD‐EHBF models had the highest maximum likelihood chi square value and the lowest AIC value among MELD‐EHBF ,CTP ,MELD ,MELD‐Na ,and MELD‐ICG .The area under ROC curve of MELD‐EHBF was 0 .756 （95% CI 0 .632 ,0 .856） and the critical value was 0 .5177 ,with the sensitivity of 47 .6% and the specificity of 95 .2% .MELD‐EHBF had the biggest area under ROC curve , which was significantly better than the CTP score and KCH standard （P〈0 .05） and was also superior to MELD and EHBF （P〈0 .05） .Conclusion The MELD‐EHBF model had a good predictive value for short‐term prognosis of patients with ACLF ,better than single MELD and EHBF .

关 键 词：慢加急性肝衰竭 短期预后 有效肝血流量 MELD-EHBF模型 

分 类 号：R575.3[医药卫生—消化系统]