MELD-Na、CLIF-C OFs、COSSH-ACLFs、NLR评分体系在乙型肝炎病毒相关慢加急性肝衰竭患者中的应用价值研究  

Study on the application value of MELD-Na,CLIF-C OFs,COSSH-ACLFs and NLR scoring systems in patients with hepatitis B virus related acute-on-chronic liver failure

作　　者：苗静[1] 郭丽颖[1] 王丽[1] 崔换天 李秋伟[1] 王静[1] 朱波 贾建伟[1] Miao Jing;Guo Liying;Wang Li;Cui Huantian;Li Qiuwei;Wang Jing;Zhu Bo;Jia Jianwei(Tianjin Second People's Hospital,Tianjin 300192,China;Shandong University,Qingdao 266237,Shandong,China)

机构地区：[1]天津市第二人民医院中西医结合Ⅰ科,天津300192 [2]山东大学生命科学学院,青岛266237

出　　处：《中华危重病急救医学》2020年第12期1496-1501,共6页Chinese Critical Care Medicine

基　　金："十三五"国家科技重大专项(2018ZX10725506-002);天津市卫生健康委员会中医药重点领域科研项目(2020006)。

摘　　要：目的评估终末期肝病模型联合血清钠评分(MELD-Na)、慢性肝衰竭-序贯器官衰竭评估模型简化评分(CLIF-C OFs)、中国重型乙型肝炎(乙肝)研究组乙肝相关的慢加急性肝衰竭预后评分(COSSH-ACLFs)、中性粒细胞/淋巴细胞比值(NLR)评分系统在乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者中的应用价值。方法回顾性收集2010年7月至2018年7月天津市第二人民医院收治的163例HBV-ACLF患者的临床资料(性别、年龄、疾病分期)以及实验室检查指标〔丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBil)、白蛋白(ALB)、血尿素氮(BUN)、肌酐(Cr)、血钠(Na)、凝血酶原活动度(PTA)、国际标准化比值(INR)、中性粒细胞计数(NEU)、淋巴细胞计数(LYM)〕,以入院8周为观察时间节点,根据预后不同将患者分为存活组(90例)和死亡组(73例)。比较死亡组和存活组的MELD-Na、CLIF-C OFs、COSSH-ACLFs评分及NLR差异,并行Logistic回归分析,确定HBV-ACLF的独立危险因素。行倾向匹配分析,验证独立危险因素的准确性,绘制受试者工作特征曲线(ROC),判断独立危险因素的临床价值。结果存活组和死亡组患者入院时性别、疾病分期、ALB、BUN、Cr、Na、NEU水平比较差异均无统计学意义(均P>0.05);存活组年龄、ALT、AST、TBil、INR水平均明显低于死亡组〔年龄(岁):43.00(34.00,53.00)比50.00(42.50,55.00),ALT(U/L):252.90(61.43,613.33)比359.10(115.15,784.70),AST(U/L):146.15(90.88,449.30)比237.80(10^(9).00,635.05),TBil(μmol/L):265.10(183.10,347.60)比307.50(229.90,405.55),INR:2.13(1.91,2.46)比2.29(2.02,2.94)〕,PTA和LYM水平均明显高于死亡组〔PTA(%):34.00(28.00,38.00)比31.00(24.00,36.00),LYM(×10^(9)/L):1.37(0.72,1.79)比0.85(0.51,1.39),均P<0.05〕;与死亡组比较,存活组MELD-Na、CLIF-C OFs、COSSH-ACLFs评分及NLR均更低〔MELD-Na评分(分):17.99(16.60,19.63)比19.16(17.43,20.80),CLIF-C OFs评分(分):9.00(8.00,9.00)比9.00(9.00,10.00),COSSH-ACLObjective To verify the accuracy of the model for end-stage liver disease-sodium(MELD-Na),chronic liver failure consortium organ failure score(CLIF-C OFs),Chinese Group on the Study of Severe Hepatitis B-Acute-on-chronic Liver Failure score(COSSH-ACLFs)and neutrophil-to-lymphocyte ratio(NLR)scoring systems in patients with hepatitis B virus related acute-on-chronic liver failure(HBV-ACLF)and to explore its value in clinical application.Methods The clinical data(gender,age,disease stage)and laboratory indicators[alanine transferase(ALT),glutamate transaminase(AST),total bilirubin(TBil),albumin(ALB),blood urea nitrogen(BUN),creatinine(Cr),serum sodium(Na),prothrombin activity(PTA),international standardized ratio(INR),neutrophils count(NEU)and lymphocytes count(LYM)]of 163 patients with HBV-ACLF from July 2010 to July 2018 in Tianjin Second People's Hospital were retrospectively analyzed.After 8 weeks of admission,the patients were divided into death group(90 cases)and survival group(73 cases)according to survival status.The MELD-Na,CLIF-C OFs,COSSH-ACLFs scores and NLR of death group and survival group were compared,and a multivariate Logistic regression analysis was used to analyze the independent risk factors for HBV-ACLF.Propensity score analysis was used to demonstrate the accuracy of the method and receiver operating characteristic curve(ROC)was used to analyze the diagnostic value of the independent risk factors.Results There were no significant differences in gender,disease stage,ALB,BUN,Cr,Na,NEU on admission between the two groups(all P>0.05).The age[years old:43.00(34.00,53.00)vs.50.00(42.50,55.00)]and serum levels of ALT[U/L:252.90(61.43,613.33)vs.359.10(115.15,784.70)],AST[U/L:146.15(90.88,449.30)vs.237.80(10^(9).00,635.05)],TBil[μmol/L:265.10(183.10,347.60)vs.307.50(229.90,405.55)]and INR[2.13(1.91,2.46)vs.2.29(2.02,2.94)]in survival group were lower than those in death group and the PTA[%:34.00(28.00,38.00)vs.31.00(24.00,36.00)]and LYM[×10^(9)/L:1.37(0.72,1.79)vs.0.85(0.51,1.39)]levels were signifi

关 键 词：乙型肝炎病毒相关慢加急性肝衰竭 终末期肝病模型联合血清钠评分 慢性肝衰竭-序贯器官衰竭评估模型简化评分 中国重型乙型肝炎研究组乙肝相关的慢加急性肝衰竭预后评分 中性粒细胞/淋巴细胞比值 

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