凝血酶原国际标准化比值/白蛋白对失代偿期肝硬化患者预后的预测价值  

Value of prothrombin time-international normalized ratio to albumin ratio in predicting the prognosis of patients with decompensated cirrhosis

作　　者：孟淑慧 胥莹[1] 邹松龙 张雪[1] 吴杰芳 MENG Shuhui;XU Ying;ZOU Songlong;ZHANG Xue;WU Jiefang(Department of Gastroenterology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China)

机构地区：[1]昆明医科大学第二附属医院消化内科,昆明650101

出　　处：《临床肝胆病杂志》2021年第9期2081-2086,共6页Journal of Clinical Hepatology

摘　　要：目的探讨凝血酶原国际标准化比值/白蛋白(PTAR)评估失代偿期肝硬化患者预后的临床价值。方法回顾性分析2016年4月—2017年4月昆明医科大学第二附属医院收治的172例失代偿期肝硬化患者的临床资料,包括性别、年龄、病因、并发症、入院后首次的实验室指标检测等。以死亡为终点事件,根据随访2年的疾病转归情况将所纳入患者分为生存组(n=98)和死亡组(n=74)。分析影响预后的相关因素,并评估PTAR对失代偿期肝硬化患者预后的预测价值。计量资料两组间比较采用t检验或Mann-Whitney U检验。计数资料两组间比较采用χ2检验或Fisher确切概率法。对相关变量行单因素和多因素Cox回归分析。绘制受试者工作特征曲线(ROC曲线),计算曲线下面积(AUC),并根据ROC曲线的敏感度和特异度确定最佳临界值。运用Kaplan-Meier生存曲线分析不同PTAR、吲哚菁绿15 min滞留率(ICGR15)、MELD评分患者的2年生存率,并采用log-rank检验比较组间差异。结果死亡组患者的PTAR(Z=-7.823,P<0.001)、ICGR15(t=3.458,P=0.001)及MELD评分(t=5.921,P<0.001)均明显高于生存组。PTAR、ICGR15、MELD评分预测患者2年预后的最佳临界值分别为0.05、41.00%、37.25分,AUC分别为0.849、0.651、0.724。生存分析提示高水平PTAR组(PTAR≥0.05)患者生存率显著低于低水平PTAR组(PTAR<0.05)(χ2=60.07,P<0.001)。多因素Cox回归分析结果显示,PTAR≥0.05是患者2年死亡的独立危险因素(HR=2.564,95%CI:1.276~5.151,P=0.008)。结论PTAR≥0.05可作为失代偿期肝硬化患者2年死亡的独立预测因子,PTAR对失代偿肝硬化患者预后有较高的预测价值。Objective To investigate the value of prothrombin time-international normalized ratio to albumin ratio(PTAR)in evaluating the prognosis of patients with decompensated cirrhosis.Methods A retrospective analysis was performed for the clinical data of 172 patients with decompensated cirrhosis who were admitted to The Second Affiliated Hospital of Kunming Medical University from April 2016 to April 2017,including sex,age,etiology,complications,and first examination of laboratory markers after admission.With death as the outcome event,the patients were divided into survival group with 98 patients and death group with 74 patients according to the outcome of the disease after 2 years of follow-up.The influencing factors for prognosis were analyzed,and the value of PTAR in predicting the prognosis of patients with decompensated cirrhosis were evaluated.The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups,and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups.Univariate and multivariate Cox regression analyses were performed for related variables.The receiver operating characteristic(ROC)curve was plotted and the area under the ROC curve(AUC)was calculated,and the optimal cut-off value was determined according to the sensitivity and specificity of the ROC curve.The Kaplan-Meier survival curve analysis was performed to compare 2-year survival rate between patients with different values of PTAR,indocyanine green retention rate at 15 minutes(ICGR15),and Model for End-Stage Liver Disease(MELD)score,and the log-rank test was used for comparison between groups.Results Compared with the survival group,the death group had significantly higher PTAR(Z=-7.823,P<0.001),ICGR15(t=3.458,P=0.001),and MELD score(t=5.921,P<0.001).PTAR,ICGR15,and MELD score had optimal cut-off values of 0.05,41.00%,and 37.25,respectively,in predicting 2-year prognosis,with AUCs of 0.849,0.651,and 0.724,respectively.The survival analysis showed that the high-P

关 键 词：肝硬化 预后 血清白蛋白 国际标准化比值 

分 类 号：R575.2[医药卫生—消化系统]