人工肝治疗慢加急性肝功能衰竭后血清总红胆素变化水平与预后分析  

Correlation between the level of serum total bilirubin change after artificial liver treatment and the prognosis of patients with acute-on-chronic liver failure

作　　者：王铭[1] 周威龙[1] 陈芳[1] 许艳[1] 唐红[1] 

机构地区：[1]四川大学华西医院感染性疾病中心,四川成都610041

出　　处：《实用医院临床杂志》2016年第5期54-58,共5页Practical Journal of Clinical Medicine

摘　　要：目的建立简易预后模型总胆红素反弹率(TBRR)、总胆红素存留率(TBARR),并评价其临床应用价值。方法回顾性分析303例经人工肝治疗的慢加急性肝功能衰竭患者的临床资料,分析MELD、MELD-Na、CTP评分系统在不同临床结局患者中的差异,并在此基础上通过ROC曲线评估TBRR、TBARR的预后预测能力,观察终点为3个月。结果死亡组MELD、MELD-Na、CTP评分及TBRR、TBARR均高于存活组(P<0.05)。ROC曲线分析中,TBARR、TBRR、MELD、MELD-Na、CTP的AUC分别为0.751、0.531、0.783、0.777、0.771,除TBRR外,余四种预后模型均提示了较好的预测分辨度且AUC值无统计学差异(P>0.05)。结论与传统的肝病预后模型MELD、MELD-Na、CTP相比,简易预后模型TBARR的预后预测能力无显著性差异,具有临床应用价值。Objective To establish and evaluate the simple prognostic model based on the total bifirubin rebound rate （TBRR） and total bilirubin actual resident ratio （TBARR）. Methods Three hundred and three cases with HBV related acute-onchronic liver failure was retrospectively analyzed. According to the variation of MELD, MELD-Na and CTP model among the different clinical outcomes, the potency of TBRR and TBARR for prognostic prediction was estimated through ROC curves at the end of 90-day observation. Results The scores of MELD-Na, MELD, CTP, TBRR and TBARR in the death group was significantly higher than those in the survival group （P 〈 0.05）. AUC of TBARR, TBRR, MELD, MELI）-Na and CTP was 0. 751,0.531,0.783, 0.777 and 0. 771, respectively. Apart from TBRR, all the models manifested no significant difference on prognostic efficiency due to AUC （P 〉 0.05 ）. Conclusion Comparing to the classic prognostic model, TBARR based model shows no significant difference on prognostic efficiency, which means a potential value for clinical use.

关 键 词：人工肝 慢加急性肝衰竭 血清总胆红素 预后 相关性分析 

分 类 号：R459.5[医药卫生—治疗学] R575.3[医药卫生—临床医学]