凝血酶原国际标准化比值/白蛋白、终末期肝病模型联合血清钠和高密度脂蛋白胆固醇联合检测对慢加急性肝衰竭患者预后的预测价值  

Predictive value of combined detection of prothrombin time-international normalized ratio-to-albumin ratio,model for end-stage liver disease-Na and high-density lipoproteincholesterol in prognosis of patients with acute-on-chronic liver failure

作　　者：王娟[1] 章颖[1] 刘先进[1] 朱晓红[1] WANG Juan;ZHANG Ying;LIU Xianjin;ZHU Xiaohong(Department of Infectious Disease,the Third People′s Hospital of Nantong in Jiangsu Province,Nantong Third Hospital Affiliated to Nantong University,Nantong,Jiangsu,226006)

机构地区：[1]江苏省南通市第三人民医院/南通大学附属南通第三医院感染科,江苏南通226006

出　　处：《实用临床医药杂志》2023年第19期94-100,共7页Journal of Clinical Medicine in Practice

基　　金：江苏省南通市市级科技计划项目(MSZ20172);江苏省南通市卫生健康委员会科研立项项目(MA2019007)。

摘　　要：目的 探讨凝血酶原国际标准化比值/白蛋白(PTAR)、终末期肝病模型联合血清钠(MELD-Na)和高密度脂蛋白胆固醇(HDL-C)联合检测对慢加急性肝衰竭(ACLF)患者预后的预测价值。方法 回顾性分析154例ACLF患者的临床资料,根据确诊第90天的预后情况分为生存组(95例)和死亡组(59例)。比较2组患者入院时的临床基线指标。分析PTAR、HDL-C、MELD-Na之间的相关性。分析ACLF患者预后的影响因素。绘制PTAR、HDL-C、MELD-Na单项及联合预测(PTAR+MELD-Na+HDL-C)模型的受试者工作特征(ROC)曲线,评估其对ACLF患者预后的预测效能。根据联合模型的截断值(0.530),将患者分为A组(<0.530,n=47)和B组(≥0.530,n=107)。采用Kaplan-Meier曲线分析比较2组生存率。结果 2组患者年龄、总胆红素(TBil)、白蛋白(ALB)、血肌酐(Cr)、凝血酶原时间(PT)、血清钠(Na+)、白细胞(WBC)、血小板(PLT)、PTAR、HDL-C、MELD-Na比较,差异有统计学意义(P<0.05)。PTAR与MELD-Na呈正相关(r=0.407,P<0.001);PTAR、MELD-Na与HDL-C呈负相关(r=-0.316、-0303,P<0.001)。年龄、TBil、PT、PTAR、MELD-Na是ACLF患者预后的独立影响因素(P<0.05), HDL-C是ACLF患者预后的有效预测因子。PTAR、HDL-C、MELD-Na的曲线下面积(AUC)分别为0.722、0.717、0.738;联合预测模型的AUC为0.801(95%CI:0.722~0.881,P<0.001),敏感度为0.627,特异度为0.916,约登指数为0.543,截断值为0.530。Kaplan-Meier曲线分析显示,A组患者累计生存率高于B组,差异有统计学意义(P<0.001)。结论 PTAR、HDL-C、MELD-Na均是ACLF患者近期预后的独立影响因素,上述三者联合预测模型对ACLF患者预后的预测价值较好。Objective To explore the predictive value of combined detection of prothrombin time-international normalized ratio-to-albumin ratio(PTAR),model for end-stage liver disease-Na(MELD-Na)and high-density lipoproteincholesterol(HDL-C)in prognosis of patients with acute-on-chronic liver failure(ACLF).Methods The clinical data of 154 patients with ACLF were retrospec-tively analyzed and divided into survival group(95 cases)and death group(59 cases)according to the prognosis on the 90th day after diagnosis.The clinical baseline indexes at admission were com-pared between the two groups.The correlations among PTAR,HDL-C and MELD-Na were analyzed.The prognostic factors of ACLF patients were analyzed.Receiver operating characteristic(ROC)curves of PTAR,HDL-C,MELD-Na and their combination prediction(PTAR+MELD-Na+HDL-C)models were drawn to evaluate their prognostic efficacy in ACLF patients.According to the truncation value(0.530)of the combined model,patients were divided into group A(<0.530,n=47)and group B(≥0.530,n=107).The survival rates of the two groups were compared by Kaplan-Meier curve analysis.Results There were significant differences in age,total bilirubin(TBil),albumin(ALB),creatinine(Cr),prothrombin time(PT),serumsodium(Na+),whiteblood cell(WBC),platelet(PLT),PTAR,HDL-C and MELD-Na between two groups(P<0.05).PTAR was positively correlated with MELD-Na(r=0.407,P<0.001);PTAR and MELD-Na were nega-tively correlated with HDL-C(r=-0.316,-0303,P<0.001).Age,TBil,PT,PTAR and MELD-Na were independent influencing factors for the prognosis of ACLF patients(P<0.05),and HDL-C was an effective predictor of the prognosis of ACLF patients.The area under curves(AUC)of PTAR,HDL-C and MELD-Na were 0.722,0.717 and 0.738,respectively;the AUC of the com-bined prediction model was 0.801(95%CI,0.722 to 0.881,P<0.001),the sensitivity was 0.627,the specificity was 0.916,the Jorden index was 0.543,and the cutoff value was 0.530.Kaplan-Meier curve analysis showed that the cumulative survival rate in the group A was significantly higher t

关 键 词：慢加急性肝衰竭 凝血酶原国际标准化比值/白蛋白 高密度脂蛋白胆固醇 终末期肝病模型联合血清钠 预后 

分 类 号：R575.3[医药卫生—消化系统] R446[医药卫生—内科学]