PTAR联合ICGR15对乙肝肝硬化患者发生慢加急性肝衰竭的预测价值研究  

Clinical significance of PTAR and ICGR15 joint score in predicting the occurrence of acute-on-chronic liver failure in patients with hepatitis B cirrhosis

作　　者：康宁 王存凯 齐丽翠 袁岳 刘丽 白云[1] 郑吉敏[1] 王玉珍[1] KANG Ning;WANG Cun-kai;QI Li-cui;YUAN Yue;LIU Li;BAI Yun;ZHENG Jimin;WANG Yu-zhen(Department of Gastroenterology,Hebei General Hospital,Shi jiazhaung 050000,China)

机构地区：[1]河北省人民医院消化科,河北石家庄05000l [2]惠州市第一人民医院

出　　处：《中国实用内科杂志》2020年第7期558-562,共5页Chinese Journal of Practical Internal Medicine

基　　金：河北省2019年度医学科学研究课题(20190260)。

摘　　要：目的探讨凝血酶原国际标准化比值与白蛋白比值(PTAR)联合吲哚菁绿清除试验15 min滞留率(ICGR15)对乙肝肝硬化患者发生慢加急性肝衰竭(ACLF)的预测价值。方法河北省人民医院消化科2016年9月至2019年9月期间收治的乙肝肝硬化患者195例,收集患者临床资料并计算出PTAR、白蛋白-吲哚菁绿评分(ALICE)。根据随访记录,21例进展为ACLF,将此定义为ACLF组,否则定义为非ACLF组。分析PTAR及ICGR15是否为ACLF发生的影响因素,并经Logistic多因素回归分析建立PTAR-ICGR15联合模型,绘制受试者工作特征曲线(ROC),分析其对ACLF发生的预测价值,并与ALICE进行对比。结果 Logistic单因素回归分析提示PTAR(P<0.001)及ICGR15(P<0.001)均为影响乙肝肝硬化患者进展为ACLF的影响因素。Logistic多因素回归分析提示PTAR(P=0.003)及ICGR15(P=0.001)均为ACLF发生的独立影响因素,并建立联合公式:0.06×ICGR15+0.058×PTAR×1000-7.249。ROC显示PTAR与ICG15的曲线下面积(AUC)分别为0.776、0.799,PTAR-ICGR15为0.860,ALICE为0.812。结论 PTARICGR15联合模型对预测ACLF发生有较好的预测价值。Objective To explore the value of PTAR combined with ICGR15 in predicting the occurrence of acute-onchronic liver failure(ACLF)in patients with hepatitis B cirrhosis. Methods Totally 195 patients with hepatitis B cirrhosis were included. General clinical data were collected,and PTAR and ALICE were calculated.According to the follow-up records,21 patients eventually developed into ACLF,who were defined as ACLF group.Others were defined as non-ACLF group. Analysis was made to find whether PTAR and ICGR15 were influencing factors of ACLF occurence. PTAR-ICGR15 joint model was established by the Logistic multivariate regression analysis. The receiver-operating characteristic Curve(ROC)was drawn to analyse the predictive value of PTAR-ICGR15 in ACLF,which was then compared with ALICE.Results Logistic univariate regression analysis of PTAR and ICGR15 showed that PTAR(P<0.001)and ICGR15(P<0.001)were both risk factors affecting the progression of patients with hepatitis B cirrhosis into ACLF. The Logistic multivariate regression analysis indicated that PTAR(P=0.003)and ICGR15(P=0.001)were both independent factors influencing the occurrence of ACLF,and a joint formula was established:0.06×ICGR15+0.058×PTAR×100-7.249. ROC showed that the area under the curve of PTAR and ICG15 was 0.776 and 0.799, respectively,PTAR-ICGR15 was 0.86 and ALICE was0.812. Conclusion PTAR-ICGR15 joint model is a more accurate indicator for predicting the occurrence of ACLF,and has good predictive value.

关 键 词：乙肝肝硬化 慢加急性肝衰竭 PTAR评分 吲哚菁绿清除试验 ALICE评分 

分 类 号：R575.2[医药卫生—消化系统] R575.3[医药卫生—内科学]