胃气定量评估在脓毒症肝衰竭/肝衰竭前期的预测效能研究  

Predictive Efficacy of Quantitative Assessment of“Stomach Qi”in Sepsis-Related Liver Failure/Pre-Liver Failure

作　　者：罗晓丹 林举择[2] 黄丹[2] 黄旭晖[2] 曾红科[1,2] Luo Xiaodan;Lin Juze;Huang Dan;Huang Xuhui;Zeng Hongke(School of Medicine,South China University of Technology,Guangdong,Guangzhou 510006,China)

机构地区：[1]华南理工大学医学院,广东广州510006 [2]广东省人民医院,广东省医学科学院,广东广州510080

出　　处：《中国中医急症》2021年第9期1554-1557,1571,共5页Journal of Emergency in Traditional Chinese Medicine

基　　金：广东省中医药局科研项目(20181007)。

摘　　要：目的探讨胃气定量评估在脓毒症肝衰竭/肝衰竭前期的预测效能。方法纳入脓毒症患者86例,进行肝功能胃气定量评估、MELD评分、CTCAE分级,同时进行危重症评分包括格拉斯哥昏迷指数(GCS)评分、序贯器官衰竭评分(SOFA)、急性生理与慢性健康评分(APACHEⅡ)评分;使用独立样本t检验、Spearman相关分析、Pearson相关分析,评价胃气定量评估在肝功能评估的稳定性与一致性;使用ROC分析胃气定量评估、MELD评分、CTCAE分级对脓毒症肝衰竭/肝衰竭前期的预测效能;Logistic回归分析各评估模型对脓毒症死亡的预测价值。结果胃气定量评估与MELD评分的相关系数rs=0.492,P值为0.000,相关关系有统计学意义;胃气定量评估与CTCAE评分的相关系数rp=0.910,P值为0.000,相关关系有统计学意义。3种肝功能评估模型对肝衰竭/肝衰竭前期的ROC曲线下面积以胃气定量评估最大为0.922,P值为0.000,预测阈值为14(敏感度0.882,特异性0.884),预测效能最理想。死亡多因素Logistic回归分析得出胃气定量评估是脓毒症死亡的独立危险因素[HR=1.269(1.099~1.464),P=0.001]。结论胃气定量评估与MELD评分及CTCAE分级相比,不因肝外因素影响个别指标变化,进而影响肝功能评估的准确性,对脓毒症肝衰竭/肝衰竭前期具有敏感度及特异性均较高的预警效能,对脓毒症的预后判断具有重要预测价值。Objective:To investigate the predictive efficacy of quantitative evaluation of“Stomach Qi”in sepsis-related liver failure/pre-liver failure. Methods:A total of 86 patients with sepsis were included for liver function evaluation,including the quantitative evaluation of“Stomach Qi”,MELD and CTCAE. Also the critical illness scores were carried out,including Glasgow Coma index(GCS),Sequential Organ Failure Score(SOFA),Acute Physiology And Chronic Health score(APACHEⅡ. The stability and consistency of quantitative assessment of“Stomach Qi”in the assessment of liver function were evaluated by independent sample T-test,Spearman correlation analysis and Pearson correlation analysis. ROC was used to analyze the predictive efficacy of quantitative evaluation of“Stomach Qi”,MELD and CTCAE in sepsis-related liver failure/pre-liver failure. The predictive value of each evaluation model for sepsis mortality was analyzed by Logistic Regression. Results:There was significant correlation between quantitative evaluation of“Stomach Qi”and MELD(rs=0.492,P = 0.000),and also between quantitative evaluation of“Stomach Qi”and CTCAE(rp = 0.910,P = 0.000). The largest area under the ROC curve of the three models for liver failure/pre liver failure was in the quantitative evaluation model of“Stomach Qi”(0.922,P = 0.000),and the prediction threshold was 14(sensitivity 0.882,specificity 0.884). Multivariate logistic regression analysis showed that quantitative assessment of“Stomach Qi”was an independent risk factor for sepsis mortality[HR = 1.269(1.099~1.464),P = 0.001]. Conclusion:Compared with MELD and CTCAE,the quantitative evaluation of“Stomach Qi”does not affect by extrahepatic factors. It has high sensitivity and specificity for the early warning of sepsis-related liver failure/pre-liver failure,and has important predictive value for the prognosis of sepsis.

关 键 词：脓毒症 肝衰竭 胃气 肝功能 

分 类 号：R285.5[医药卫生—中药学]