多种模型预测HBV-ACLF合并IPA患者的短期预后价值分析  

Analysis of short-term prognostic value of multiple models in predicting HBV-ACLF complicated with IPA

作　　者：梁佳圆 邬小萍[1] 杨丽霞[1] 蔡天盼 王亮[1] 程齐齐 孙俊 刘丽萍 甘厦 阮宁杭 葛善飞[1] Liang Jiayuan;Wu Xiaoping;Yang Lixia;Cai Tianpan;Wang Liang;Cheng Qiqi;Sun Jun;Liu Liping;Gan Xia;Ruan Ninghang;Ge Shanfei(Department of Infectious Diseases,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Information Center,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Medical College of Nanchang University,Nanchang 330001,China)

机构地区：[1]南昌大学第一附属医院感染性疾病科,南昌330006 [2]南昌大学第一附属医院信息处,南昌330006 [3]南昌大学医学院,南昌330031

出　　处：《新发传染病电子杂志》2022年第4期20-24,共5页Electronic Journal of Emerging Infectious Diseases

基　　金：江西省自然科学基金重大专项计划(20212ACB206010);江西省自然科学基金面上项目(20192BAB205090)。

摘　　要：目的应用终末期肝病模型(MELD)评分、终末期肝病联合血清钠模型(MELD-Na)评分、慢性肝功能衰竭联盟-器官功能衰竭(CLIF-C OF)评分和慢性肝衰竭联盟-慢加急性肝衰竭预后(CLIF-C ACLF)评分对乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)合并侵袭性肺曲霉病(IPA)患者短期死亡风险进行预测,探讨并比较各种评分系统对HBV-ACLF合并IPA患者短期病死率的预测价值。方法收集南昌大学第一附属医院感染科2019年1月至2021年12月收治的HBV-ACLF患者的临床资料。根据是否诊断为IPA分为IPA组和非IPA组,随访记录HBV-ACLF患者自诊断后28d的临床转归情况。分别计算MELD评分、MELD-Na评分、CLIF-C OF评分和CLIF-C ACLF评分,应用ROC曲线比较以上评分系统的预测价值。符合正态分布者两组间的比较采用t检验,不符合正态分布者两组间的比较采用Mann-Whitney U检验。结果在110例患者中,治疗28d死亡36例(32.7%)。MELD评分、MELD-Na评分、CLIF-C OF评分和CLIF-C ACLF评分预测HBV-ACLF合并IPA患者28d死亡风险的ROC曲线下面积(AUC)分别为0.77、0.74、0.93和0.89。CLIF-C OF评分的AUC最大,与CLIF-C ACLF评分AUC的比较差异无统计学意义(P>0.05)。CLIF-C OF评分、CLIF-C ACLF评分与MELD评分和MELD-Na评分AUC的比较差异均有统计学意义(P<0.05)。结论CLIF-C OF评分和CLIF-C ACLF评分能有效预测ACLF合并IPA患者28d的死亡风险。Objective MELD score,MELD-Na score,CLIF-C OF score,and CLIF-C ACLF score were used to predict the short-term mortality risk in patients with hepatitis B virus-related acute-onchronic liver failure(HBV-ACLF)complicated with invasive pulmonary aspergillosis(IPA),to explore and compare the predictive value of various scoring systems for the short-term fatality rate in patients with HBV-ACLF incorporates the IPA.Method Collect the clinical data of HBV-ACLF patients who admitted to the Infection Department of the First Affiliated Hospital of Nanchang University from January 2019 to December 2021.The MELD score,MELD-Na score,CLIF-C OF score and CLIF-C ACLF score were calculated respectively,and the receiver operating characteristic curve(ROC curve)was applied to compare the diagnostic value of the above scoring system.Comparisons between two groups meeting the normal distribution were performed by the t-test,Comparisons between two groups who did not fit the normal distribution were performed using the Mann-Whitney U test.Result Among the 110 patients,36 patients(32.7%)died after 28 days of treatment.The area under the ROC curve(AUC)of the MELD score,MELD-Na score,CLIF-C OF score and CLIF-C ACLF score was 0.77,0.74,0.93 and 0.89,respectively.The AUC of CLIF-C OF score was the largest,and there was no significant difference with CLIF-C ACLF score(P>0.05).There were significant differences in AUC between CLIF-C OF score,CLIF-C ACLF score,MELD score and MELD-Na score(P<0.05).Conclusion The CLIF-C OF score and CLIF-C ACLF score can effectively predict the 28-day risk of death in patients with ACLF incorporates the IPA.

关 键 词：慢加急性肝衰竭 乙型肝炎病毒 曲霉菌 预后 

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