系统炎症指标联合MELD评分的动态变化评估慢加急性肝衰竭患者的短期预后价值  

Value of dynamic changes of systemic inflammatory markers and MELD score in evaluating short-term prognosis of patients with acute-on-chronic liver failure

作　　者：牛俊丽 陈伟 刘波 NIU Junli;CHEN Wei;LIU Bo(Postgraduate Union Training Basement,Xiangyang First People’s Hospital,Hubei College of Medicine,Jinzhou Medical University,Xiangyang 4A1000,CHINA)

机构地区：[1]锦州医科大学湖北医药学院附属襄阳市第一人民医院研究生联合培养基地,湖北襄阳441000 [2]湖北医药学院附属襄阳市第一人民医院消化内科

出　　处：《江苏医药》2022年第4期357-363,共7页Jiangsu Medical Journal

基　　金：湖北省教委科研基金(B2015489)。

摘　　要：目的分析系统炎症指标联合终末期肝病模型(MELD)评分的动态变化评估慢加急性肝衰竭(ACLF)患者的短期预后价值.方法回顾性分析111例ACLF患者临床资料,根据患者90 d存活情况分为生存组(64例)与死亡组(47例).采用logistic回归分析ACLF患者短期不良预后的影响因素.采用ROC曲线分析患者确诊第1天炎性指标、MELD评分及年龄-血小板/白细胞比值(PWR)-MELD模型对ACLF患者90 d内死亡的预测价值.分析ACLF患者第1天及第7天中性粒细胞/淋巴细胞比值(NLR)、单核细胞/淋巴细胞比值(MLR)、PWR及MELD评分的动态变化对ACLF患者90 d内死亡的预测价值.结果死亡组患者年龄、NLR、MLR和MELD评分均高于生存组,而PWR低于生存组(P<0.05).多因素logistic回归分析结果显示,低PWR、高M ELD评分和年龄增大为ACLF患者90 d内死亡的独立危险因素(P<0.05).通过多因素logistic回归分析建立年龄-PWR-MELD新模型(logistic_(年龄-PWR-MELD)=-9.505+0.111×年龄+0.233×MELD-0.140×PWR).该模型预测ACLF患者90 d内死亡的AUC高于NLR、MLR、PWR及MELD评分单独预测的AUC(P<0.05).ROC曲线显示,确诊ACLF第7天的NLR、MLR、PWR及MELD评分的AUC高于确诊第1天(P<0.05).结论与单独使用NLR、PWR、MLR或MELD评分比较,年龄-PWR-MELD新模型对ACLF患者90 d内死亡的预测价值更高,且确诊ACLF第7天NLR、MLR、PWR和MELD评分较确诊ACLF第1天的指标预测患者预后的价值更高.Objective To analyze the value of the dynamic changes of systemic inflammatory markers combined with model for end-stage liver disease(MELD) score in evaluating the short-term prognosis of the patients with acute-on-chronic liver failure(ACLF).Methods The clinical data of 111 ACLF patients were retrospectively analyzed, who were divided into two groups of A(survival, 64 cases) and B(death, 47 cases) according to the prognosis within 90 days.The influencing factors for the short-term prognosis of the patients were analyzed by logistic regression.The ROC curve was used to compare the predictive value of inflammatory markers, MELD score and age-platelet/white blood cell ratio(PWR)-MELD model on the 11^(st) day of diagnosis for 90-day mortality of the patients.The value of the dynamic changes of neutrophil/lymphocyte ratio(NLR),monocyte/lymphocyte ratio(MLR),PWR and MELD score on the 11^(st) and 71^(th)day in evaluating the short-term prognosis of the patients were analyzed.Results The age, NLR,MLR and MELD scores in group B were higher than those in group A,but PWR was lower than that in group A(P<0.05).Multivariate logistic regression analysis showed that low PWR,high MELD score and increased age were the independent risk factors for 90-day mortality of the patients with ACLF(P<0.05).A new age-PWR-MELD model(logistic_(age-PWR-MELD)=-9.505+0.111×age+0.233×MELD-0.140×PWR) was established by multivariate logistic regression analysis.The AUC for the model to predict the 90-day mortality was higher than that by NLR,MLR,PWR or MELD score alone(P<0.05).The ROC curve analysis showed that the AUC of NLR,MLR,PWR and MELD score on the 7^(th) day after ACLF diagnosis was higher than that on the 1^(st) day(P<0.05).Conclusion Compared with the NLR,PWR,MLR or MELD score alone, the new age-PWR-MELD model has a higher predictive value for 90-day mortality of ACLF patients, and the value of the four indicators on the 7^(th) day after ACLF diagnosis in predicting the 90-day mortality of ACLF patients is more than that on the 1^(st

关 键 词：慢加急性肝衰竭 血小板/白细胞比值 中性粒细胞/淋巴细胞比值 单核细胞/淋巴细胞比值 终末期肝病模型评分 

分 类 号：R575[医药卫生—消化系统]