外周血NLR、AFP联合MELD评分系统对HBV-ACLF患者近期预后的评估价值  

The Evaluation Value of Peripheral Blood NLR,AFP Combined with MELD Scoring System for the Short-term Prognosis of HBV-ACLF Patients

作　　者：林太顺 孔金峰 王少扬 LIN Taishun;KONG Jinfeng;WANG Shaoyang(Department of Hepatology,Mengchao Hepatobiliary Hospital,Fujian Medical University,Fuzhou 350025,China;Department of Infection,The 900 Hospital of the Joint Service Support Force of the People's Liberation Army of China,Fuzhou 350025,China)

机构地区：[1]福建医科大学孟超肝胆医院肝内科,福州350025 [2]中国人民解放军联勤保障部队第九〇〇医院感染科,福州350025

出　　处：《中国医药指南》2024年第15期99-102,共4页Guide of China Medicine

摘　　要：目的探究外周血中性粒细胞和淋巴细胞的比值(NLR)、甲胎蛋白(AFP)+终末期肝病模型(MELD)评分系统在判断乙型肝炎病毒相关慢加急(亚急)性肝衰竭(HBV-ACLF)患者近期预后方面的意义,以指导有关疾病研究和相关治疗干预工作的开展。方法选择2018年1月至2018年12月被福建医科大学孟超肝胆医院所接收HBV-ACLF患者115例并实施回归性分析,按预后近期3个月内的病情转归将患者分为好转组与无效/恶化组,然后做如下分析:①应用Logistic回归分析HBVACLF患者的性别、年龄以及入院24 h的血常规指标、肝功能指标、甲胎蛋白、C反应蛋白、降钙素原、血肌酐、血氨、钠、病史及并发症与近期预后的相关性。②用ROC曲线评价和预后明显相关指标监测HBV-ACLF患者近期预后的临床价值。结果恶化/无效组的NLR水平与MELD评分均高于好转组,而好转组的AFP值高于恶化/无效组(P<0.05)。通过ROC曲线分析表明,NLR、AFP+MEL对HBV-ACLF患者近期预后具有最高的预后准确度价值,其曲线包围的图形有最大的面积为0.880,NLR、AFP+MELD评分系统评估患者治疗无效/恶化组的敏感度、特异度、阳性预测及阴性预测的数值分别为90.00%、75.38%、73.77%及90.74%。结论NLR、AFP+MELD评分在HBV-ACLF患者3个月的预后评估方面具有更高预测效力,可引导HBV-ACLF临床治疗工作的开展。Objective To explore the significance of the peripheral blood granulocyte to lymphocyte ratio(NLR),alpha fetoprotein(AFP)+end stage liver disease model(MELD)scoring system in predicting the short-term prognosis of patients with hepatitis B virus associated chronic/subacute(HBV-ACLF)liver failure,in order to guide disease research and related treatment interventions.Methods A total of 115 patients with HBV-ACLF who were admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2018 to December 2018 were selected and subjected to regression analysis.The patients were divided into improvement group and ineffective/worsening group according to the prognosis within the past three months.The following analysis was conducted:①Logistic regression analysis was applied to investigate the correlation between gender,age,blood routine indicators,liver function indicators,alpha fetoprotein,C-reactive protein,procalcitonin,blood creatinine,blood ammonia,sodium,medical history,and complications with recent prognosis in HBV-ACLF patients.②The clinical value of using ROC curve to evaluate and monitor the short-term prognosis of HBV-ACLF patients with significantly correlated prognostic indicators.Results The NLR level and MELD score of the deterioration/ineffective group were higher than those of the improvement group,while the alpha fetoprotein value of the improvement group was higher than that of the deterioration/ineffective group(P<0.05).Through ROC curve analysis,it is shown that NLR,AFP+MEL have the highest prognostic accuracy value for the short-term prognosis of HBV-ACLF patients.The graph enclosed by the curve has the largest area of 0.880.The sensitivity,specificity,positive prediction,and negative prediction values of the NLR,AFP+MELD scoring system for evaluating treatment efficacy/deterioration in patients are 90.00%,75.38%,73.77%,and 90.74%,respectively.Conclusions The NLR,AFP+MELD score has higher predictive power in the 3-month prognosis evaluation of HBV-ACLF patients,and can guide

关 键 词：中性粒细胞与淋巴细胞比值 外周血中性粒细胞和淋巴细胞的比值 甲胎蛋白 终末期肝病模型评分系统 

分 类 号：R575.3[医药卫生—消化系统]