天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (4): 413-417.doi: 10.11958/20161038

• 诊断技术与方法 • 上一篇    下一篇

不同评分系统对乙型肝炎相关慢加急性肝衰竭短期预后的诊断价值

陈辰 1， 2， 3， 4， 李嘉 2， 4， 周莉 2， 4， 陆伟 1， 3， 4△   

  1. 1 天津医科大学一中心临床学院 （邮编 300192）； 2 天津市第二人民医院； 3 天津市第一中心医院； 4 天津市肝病医学研究所
  • 收稿日期:2016-09-23 修回日期:2017-03-08 出版日期:2017-04-15 发布日期:2017-04-15
  • 通讯作者: △通讯作者 E-mail: luwei1966@126.com E-mail:chenchen89122@126.com
  • 作者简介:陈辰 （1988）， 女， 硕士研究生在读， 主要从事肝病相关研究

alues of different scores for diagnosing short-term prognosis of HBV-related acute-on-chronic liver failure

CHEN Chen1,2,3,4, LI Jia2,4, ZHOU Li2,4, LU Wei1,3,4△   

  1. 1 The First Center Clinical College of Tianjin Medical University, Tianjin 300192, China; 2 Tianjin Second People’ s Hospital; 3 Tianjin First Center Hospital; 4 Tianjin Institute of Hepatology
  • Received:2016-09-23 Revised:2017-03-08 Published:2017-04-15 Online:2017-04-15
  • Contact: △Corresponding Author E-mail: luwei1966@126.com E-mail:chenchen89122@126.com

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摘要： 目的 比较终末期肝病模型联合血清钠 （MELD-Na）、 慢性肝衰竭-序贯器官衰竭评估 （CLIF-SOFA）、 亚太 肝脏研究协会慢加急性肝衰竭研究小组评分（AARC-ACLF）对乙型肝炎相关慢加急性肝衰竭患者短期预后的诊断 价值。方法 选取 72 例乙型肝炎相关慢加急性肝衰竭患者， 根据 3 个月时的预后分为 2 组， 经内科治疗病情稳定 或好转为 A 组 （29 例）， 治疗无效死亡或行肝移植者为 B 组 （43 例）。收集患者确诊或入院时的临床资料， 选取患者 住院期间国际标准化比值（INR）最低时的同期临床指标， 比较 2 组总胆红素（TBIL）、 凝血酶原时间（PT）、 INR、 血清 肌酐（Cr）、 血清钠（Na）、 白蛋白（ALB）、 MELD-Na、 CLIF-SOFA、 AARC-ACLF 分值， 应用受试者工作特征（ROC）曲线 下面积（AUC）评价上述评分系统对慢加急性肝衰竭短期预后的预测价值。结果 B 组的 TBIL、 INR、 MELD-Na、 AARC-ACLF、 CLIF-SOFA 高于 A 组， Na 低于 A 组， 差异有统计学意义 （P＜0.05）。CLIF-SOFA 评分 AUC（0.887） 优 于 MELD-Na 评分 AUC（0.764）， 差异有统计学意义（Z=2.255， P＜0.016 7）， CLIF-SOFA 与 AARC-ACLF 评分 AUC （0.825）、 MELD-Na 与 AARC-ACLF 评分 AUC 差异均无统计学意义（Z 分别为 1.361、 1.127， P ＞0.016 7）； MELDNa、 CLIF-SOFA、 AARC-ACLF 评分所得最佳临界值分别为 23.84、 8.50、 8.50。结论 3 种评分系统均能较好地预测 乙型肝炎相关慢加急性肝衰竭患者的短期临床预后， AARC-ACLF 评分系统临床应用价值更高。

关键词: 肝炎, 乙型, 慢性, 肝功能衰竭, 预后, 慢加急性肝衰竭, 终末期肝病模型联合血清钠, 慢性肝衰竭-序贯 器官衰竭评估, 亚太肝脏研究协会慢加急性肝衰竭研究小组评分

Abstract: Objective To investigate the diagnostic values of model of end-stage with incorporation of serum sodium (MELD- Na) score, chronic liver failure- sequential organ failure assessment (CLIF- SOFA) score and APASL- ACLF research consortium score (AARC- ACLF) for evaluation of prognosis of hepatitis B virus related acute- on- chronic liver failure (HBV- ACLF). Methods A total of 72 consecutive patients with HBV- ACLF were included in the study and divided into two groups (group A and group B) according to the prognosis in three-month. Group A were included 29 patients with stable disease or better after medical treatment at least for 3 months, and group B included 43 patients who were dead after treatment or received liver transplantation as failure of medical treatment. When the patients were diagnosed as ACLF or after admission, the data were collected. Results of the laboratory examination were collected when the international normalized ratio (INR) was minimum. Data of total bilirubin (TBIL), prothrombin time (PT), INR, serum creatinine (Cr), serum sodium (Na), albumin (ALB), MELD-Na, CLIF-SOFA and AARC-ACLF scores were calculated respectively. The comparative analysis was performed. Areas under the receiver operating characteristic curve (AUC-ROC) of MELD-Na and CLIF-SOFA scores were used to assess the short-term prognosis in patients with acute-on-chronic liver failure. Results The values of TBIL, INR, MELD-Na, AARC-ACLF and CLIF-SOFA were significantly higher in group B than those in group A (P＜0.05). The serum level of Na was significantly lower in group B than that of group A (P＜0.05). The area under curve (AUC) values generated by the ROC curves was higher for CLIF-SOFA score (AUC 0.887) than that of MELD-Na score (AUC 0.764) (Z=2.255, P＜0.016 7). The AUC values generated by the ROC curves showed no significant differences between CLIF-SOFA score and AARC-ACLF score (AUC 0.825) or MELD-Na score and AARC-ACLF score (Z=1.361, 1.127, P＞0.016 7). The cut- off scores of MELD- Na, CLIF- SOFA and AARC- ACLF were 23.84, 8.50 and 8.50 respectively. Conclusion MELD- Na, CLIF- SOFA and AARC- ACLF scores have appreciable values to evaluate the prognosis in patients with HBV-related ACLF. AARC-ACLF is better than that of MELD-Na and CLIF-SOFA in assessing prognosis of HBV-related ACLF

Key words: hepatitis B, chronic, liver failure, prognosis, acute- on- chronic liver failure, MELD- Na, CLIF- SOFA, AARC-ACLF