摘要
目的探讨肝脏面积与腹部面积比(liver to abdominal area ratio,LAAR)评估失代偿期肝硬化患者预后的价值.方法选取2015年7月至2016年7月青海大学附属医院消化内科住院的108例失代偿期肝硬化患者为研究对象.收集患者肝功能、肾功能及凝血功能等指标,计算LAAR、Child-Turcotte-Pugh(CTP)评分,终末期肝病模型(model for end-stage liver disease,MELD)评分.根据随访1年后患者的预后分为病死组及存活组.比较两组患者的LAAR、CTP评分及MELD评分.采用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析LAAR诊断失代偿期患者肝硬化预后的价值.采用Kaplan-Meier生存分析比较不同LAAR值患者的预后.结果病死组患者LAAR显著低于存活组[(33.67±4.28)vs(39.16±4.33)],CTP评分及MELD评分显著高于存活组,差异均有统计学意义(t=6.473,P=0.001;z=-5.595,P=0.001;t=-5.493,P=0.001).ROC曲线表明,LAAR、CTP评分和MELD评分的AUC分别为0.807(95%CI:0.725~0.890,P=0.001)、0.804(95%CI:0.715~0.893,P=0.001)和0.788(95%CI:0.693~0.883,P=0.001).LAAR的约登指数为37.30%,敏感性为0.692,特异度为0.837,3种方法预后评估价值差异无统计学意义(均P<0.05).Kaplan-Meier生存分析表明,LAAR<37.30%患者的生存率较LAAR≥37.30%患者显著下降(χ2=7.121,P=0.008),且1年后病死风险增加3.571倍.结论 LAAR对判断失代偿期肝硬化患者病情及预后具有一定价值,方法简便易行,值得推广.
Objective To evaluate the value of liver to abdominal area ratio (LAAR) on the prognosis of patients with decompensated liver cirrhosis. Methods Total of 108 patients with decompensated liver cirrhosis in Qinghai University Affiliated Hospital from July 2015 to July 2016 were selected. The indexes of liver function, renal function and coagulation function were collected. LAAR, Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease model (MELD) score were calculated. The patients were divided into death group and survival group according to the prognosis after 1 year follow-up. The LAAR, CTP score and MELD score were compared between the two groups. Receiver operating characteristic curve (ROC) were used to analyze the diagnostic value of LAAR on the prognosis of patients with decompensated liver cirrhosis. Kaplan-Meier survival analysis was used to compare the prognosis of patients with different LAAR values. Results LAAR of patients in death group was significantly lower than that in survival group [(33.67 ± 4.28) vs (39.16 ± 4.33)], the CTP score and MELD score were significantly higher than those in survival group, the differences were statistically significant (t = 6.473, P = 0.001;z =-5.595, P = 0.001;t =-5.493,P = 0.001). ROC analysis showed that the AUC of LAAR, CTP score and MELD score were 0.807 (95%CI: 0.725~0.890, P = 0.001), 0.804 (95%CI: 0.715~0.893, P = 0.001) and 0.788 (95%CI: 0.693~0.883, P = 0.001), respectively. Youden index of LAAR was 37.30%, the sensitivity was 0.692, and the specificity was 0.837. Youden index of LAAR was 37.30%, the sensitivity was 0.692 and the specificity was 0.837. Kaplan-Meier survival analysis showed that the survival rate of patients with LAAR < 37.30% was significantly lower than that of patients with LAAR ≥ 37.30%(χ2 = 7.121, P = 0.008), and the risk of death after one year increased 3.571 times. Conclusions LAAR is helpful in determining the condition and prognosis of patients with decompensated liver cirrhosis. LAAR is worth promoting due to it
作者
王昀
杨永成
WANG Yun;YANG Yong-cheng(Department of Digestive System,Qinghai University Affiliated Hospital,Xining 810000,China)
出处
《中国肝脏病杂志（电子版）》
CAS
2019年第3期47-51,共5页
Chinese Journal of Liver Diseases：Electronic Version
基金
青海省卫计委医药卫生指导性课题（2017-wjzdx-62)
