三种终末期肝病评分模型对乙型肝炎慢加急性肝功能衰竭患者短期预后的预测价值  

Predictive value of three scoring models for end-stage liver disease for short term prognosis in patients with acute-on-chronic hepatitis B liver failure

作　　者：陈学兵[1] 张浩[1] 杨家红[1] 

机构地区：[1]四川省德阳市人民医院感染科,618000

出　　处：《中华传染病杂志》2015年第8期471-475,共5页Chinese Journal of Infectious Diseases

摘　　要：目的观察HBV相关慢加急性肝功能衰竭（ACLF）住院患者基线、第1周及第2周时的终末期肝病模型（MELD）、MELD-Na和MELDNa评分对短期（3个月）病死率的预测价值。方法收集2014年1月至2015年1月在四川省德阳市人民医院住院的HBV相关ACLF患者53例，根据3个月的预后情况分为死亡组和生存组，收集两组患者的血液生物化学指标及并发症情况。两组均数比较采用t检验，计数资料采用χ2检验，各评分模型预测短期病死率的准确性采用受试者工作特征曲线下面积（AUC）表示。结果53例患者中，死亡21例，生存32例。MELD、MELD-Na及MEI。DNa评分在基线时预测患者3个月病死率的AUC分别为0．548（95％CI：0．406～0．685，P=0．555）、0．502（95％CI：0．362～0．643，P—0．978）和0．523（95％CI：0．381～0．662，P—0．778）。在第1周和第2周时，其AUC逐渐增加；第2周时的AUC分别为0．881（95％CI：0．762～0．953，P〈0．01）、0．878（95％CI：0．759～0．951，P〈0．01）和0．897（95％CI：0．783～0．963，P〈0．01），均明显高于第1周及基线时相应的值（均P〈0．05）。当阈值分别为26、29和29时，MELD、MELD-Na及MELDNa评分模型的敏感度和特异度、阳性预测值及准确度均达到最佳，亦高于基线和第1周时相应的值。结论人院第2周时MELD、MELD-Na和MELDNa评分对HBV相关ACLF患者短期病死率的预测价值优于基线及第1周，而在基线时评分的预测价值可能不佳。Objective To investigate the predictive value of the baseline, week 1 and week 2 model for end-stage liver disease （MELD） scores, MELD-Na scores and MELDNa scores for 3-month mortality in hepatitis B virus （HBV） related acute-on-chronic liver failure （ACLF） patients. Methods Fifty-three eligible HBV-related ACLF patients who received initial treatment in People＇s Hospital of Deyang City, Siehuan Province from January 2014 to January 2015 were enrolled in this retrospective clinical follow up study. Patients were divided into death group and survival group according to the prognosis after 3 months of treatment. Biochemical data and complications were collected, t test was used to compare the means between two groups and χ2 test was used to compare categorical data. Accuracy of scoring models in predicting mortality within 3 months was performed by area under receiver operating characteristic curve （AUC）. Results Of the fifty-three patients, twenty-one HBV-related ACLF patients died in 3-month, while thirty-two patients survived. The AUC of MELD scores, MELD-Na scores and MELDNa scores at the baseline in predicting 3 month mortality were 0. 548 （95%CI： 0. 406-0. 685, P=0. 555）, 0. 502 （95%CI： 0. 362-0. 643, P=0. 978） and 0. 523 （95%CI： 0. 381-0. 662, P=0. 778）, respectively. The AUC increased gradually at the first and the second week. At the second week, the AUC of MELD scores, MELD-Na scores and MELDNa scores were 0. 881 （95%CI： 0. 762-0. 953, P〈0.01）, 0. 878 （95%CI：0. 759-0. 951, P〈0.01） and 0. 897 （95%CI： 0. 783-0. 963, P〈0.01）, respectively. The AUC of the second week was higher than those of the baseline and the first week （both P〈0.05）. The sensitivity, specificity, positive predictive value （PPV）, and accuracy at the second week were best when the cut off was 26 for MELD, 29 for MELD-Na and 29 for MELDNa, and were higher than the corresponding values of the baseline and the first week. Conclusions The predictive values of MELD scores, ME

关 键 词：肝炎 乙型 慢加急性肝衰竭 终末期肝病模型 病死率 

分 类 号：R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学]