终末期肝病模型评分联合凝血酶原活动度对慢加急性肝衰竭患者3个月生存期的预后评估价值  

The value of model for end-stage liver disease score,as well as prothrombin activity level for contributing to the prognostic assessment for patients who have the risk of death in 3 months with acute-on-chronic liver failure

作　　者：刘瀛琪 李传汕 林海燕 洪维齐 LIU Yingqi;LI Chuanshan;LIN Haiyan;HONG Weiqi(Department of liver disease internal medicine,Dalian No.6 People's Hospital,Dalian,Liaoning,116033,China;Department of General surgery,Dalian No.6 People's Hospital,Dalian,Liaoning,116033,China)

机构地区：[1]大连市第六人民医院肝病内科,辽宁大连116033 [2]大连市第六人民医院普外科,辽宁大连116033

出　　处：《当代医学》2023年第11期89-93,共5页Contemporary Medicine

摘　　要：目的探讨终末期肝病模型评分(MELD)评分联合凝血酶原活动度(PTA)在慢加急性肝衰竭患者3个月生存期预后评估的价值。方法回顾性分析2020年1月至2020年12月本院收治的80例慢加急性肝衰竭患者的临床资料,随访3个月后,生存患者45例,死亡患者35例,收集两类患者临床资料[年龄、血清总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酐(Cr)、国际标准化比值(INR)、PTA、MELD评分],采用受试者工作特征曲线(ROC)评估MELD评分、PTA对慢加急性肝衰竭患者3个月生存期的预测价值。结果死亡患者血清TBIL、ALT、AST、Cr水平、INR、MELD分数均高于生存患者,PTA低于生存患者,差异有统计学意义(P<0.05)。PTA晚期病死率高于早期、中期,MELD高危人群病死率高于低危人群、中危人群,差异有统计学意义(P<0.05)。PTA、MELD评分预测慢加急性肝衰竭患者3个月死亡风险的最佳临界值分别为30.6,24.5,PTA的AUC为0.802,灵敏度为84.4%,特异度为65.7%(P<0.05),MELD评分的AUC为0.851,灵敏度为88.6%,特异度为73.3%(P<0.05)。结论PTA、MELD评分对慢加急性肝衰竭患者3个月生存期具有一定的预测价值。Objective To evaluate the value of model score of end-stage liver disease(MELD)combined with prothrombin activity(PTA)in 3-month survival prognosis of patients with chronic acute liver failure.Methods The clinical data of 80 patients with chronic acute liver failure admitted to our hospital from January 2020 to December 2020 were retrospectively analyzed.After 3 months of follow-up,45 patients survived and 35 died.Clinical data(age,serum total bilirubin[TBIL],alanine aminotransferase[ALT],aspartate aminotransferase[AST],creatinine[Cr],international standardized ratio[INR],PTA and MELD scores)were collected from two categories of patients.The predictive value of MELD score and PTA for 3-month survival in patients with chronic acute liver failure was evaluated by receiver operating(ROC)curve.Results The levels of serum TBIL,ALT,AST,Cr,INR and MELD in the death patients were higher than those in the survival group,and PTA was lower than those in survival patients,the differences were statistically significant(P<0.05).The death rate of PTA in the late stage was higher than that in the early and middle stages,and the death rate of MELD in high risk group was higher than that in low risk group and middle risk group,the difference was statistically significant(P<0.05).The optimal critical values of PTA and MELD scores for predicting 3-month risk of death in patients with chronic acute liver failure were 30.6 and 24.5,respectively;AUC of PTA was 0.802,sensitivity 84.4%,specificity 65.7%(P<0.05);AUC of MELD score was 0.851,sensitivity 88.6%;the specificity was 73.3%(P<0.05).Conclusion PTA and MELD scores can predict the 3-month survival of patients with chronic acute liver failure.

关 键 词：终末期肝病模型 慢加急性肝衰竭 凝血酶原活动度 生存期 

分 类 号：R575.3[医药卫生—消化系统]