血钙水平联合胆碱酯酶、MELD-Na评分对肝硬化失代偿患者预后评估的临床价值  

Clinical Value of Serum Calcium Level Combined With Choline Esterase and MELD-Na Score in Evaluation of Prognosis of Patients With Decompensated Cirrhosis

作　　者：刘媛 陈大军 徐微[1] LIU Yuan;CHEN Dajun;XU Wei(Department of Gastroenterology,Quzhou Affiliated Hospital of Wenzhou Medical University,People’s Hospital of Quzhou,Quzhou,Zhejiang Province,324000)

机构地区：[1]温州医科大学附属衢州医院(衢州市人民医院)消化内科,324000

出　　处：《胃肠病学》2021年第8期466-470,共5页Chinese Journal of Gastroenterology

基　　金：衢州市科技计划项目(ZD2020124)。

摘　　要：背景:肝硬化失代偿为消化内科常见病且患者预后差,目前肝硬化相关评分模型非常多,但均有一定的局限性。目的:探究血钙水平联合胆碱酯酶、MELD-Na评分对肝硬化失代偿患者预后评估的临床价值。方法:选取2017年1月-2020年12月温州医科大学附属衢州医院收治的肝硬化终末期住院患者169例,检测血钙水平、胆碱酯酶、肌酐、国际标准化比值(INR)、凝血酶原时间、总胆红素(TBIL)、血钠水平等,计算MELD评分和MELD-Na评分。采用ROC曲线分析各个指标评估肝硬化失代偿患者预后的价值。结果:随访6个月后,125例患者存活,44例死亡。存活组TBIL、肌酐、INR、凝血酶原时间、MELD评分、MELD-Na评分显著低于死亡组(P<0.05),白蛋白、血钠水平、血钙水平、胆碱酯酶显著高于死亡组(P<0.05)。ROC曲线示血钙水平、胆碱酯酶、MELD评分、MELD-Na评分评估肝硬化失代偿患者预后的AUC分别为0.824、0.783、0.781和0.839。联合血钙水平、胆碱酯酶和MELD-Na评分预测肝硬化失代偿患者短期预后的AUC升至0.897。结论:血钙水平、胆碱酯酶、MELD-Na评分三者联合对肝硬化失代偿患者6个月预后的评估有较高的预测价值。Background: Decompensated liver cirrhosis is a common disease in department of gastroenterology, and the prognosis is poor. There are many liver cirrhosis-related scoring models, but all have certain limitations. Aims: To explore the clinical value of serum calcium level combined choline esterase, MELD-Na score for predicting prognosis in patients with decompensated cirrhosis. Methods: A total of 169 patients with decompensated cirrhosis from Jan. 2017 to Dec. 2020 at the Quzhou Affiliated Hospital of Wenzhou Medical University were enrolled. Serum calcium level, choline esterase, creatinine, international normalized ratio(INR), prothrombin time, total bilirubin(TBIL) and serum sodium level were detected, and MELD score and MELD-Na score were calculated. ROC curve was used to analyze the value of parameters in evaluating prognosis of patients with decompensated cirrhosis. Results: After 6 months’ follow-up, 125 patients survived and 44 died. TBIL, creatinine, INR, prothrombin time, MELD score, MELD-Na score were significantly lower in survival group than in death group(P<0.05), while serum albumin, sodium, calcium, choline esterase levels were significantly higher(P<0.05). ROC curve showed that AUC of serum calcium level, choline esterase, MELD score and MELD-Na score for predicting prognosis of patients with decompensated cirrhosis were 0.824, 0.783, 0.781 and 0.839, respectively. AUC of serum calcium level combined with choline esterase and MELD-Na score was 0.897. Conclusions: The combination of serum calcium level, choline esterase and MELD-Na score has a higher predictive value for the 6-months prognosis of decompensated cirrhosis patients.

关 键 词：肝硬化 血钙 MELD-Na评分 胆碱酯酶类 预后 

分 类 号：R57[医药卫生—消化系统]