摘要
目的探索吲哚菁绿(ICG)清除试验对HBV相关性慢加急性肝衰竭(ACLF)患者短期预后的价值,使用吲哚菁绿15分钟滞留率(ICGR15)联合MELD评分及CTP评分建立新的预后评估模型,为构建HBV-ACLF短期预后的理想模型提供依据。方法收集2017年6月-2019年1月西南医科大学附属医院感染科收治的97例HBV-ACLF患者的临床资料,按基础肝病分为慢性乙型肝炎(CHB)组和肝硬化组,根据随访3个月时的转归分为死亡组和存活组,检测患者确诊时的ICGR15及生化、凝血等指标,同时计算CTP、MELD评分。符合正态分布的计量资料组间比较采用t检验;非正态分布计量资料组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ2检验,ICGR15与各变量之间的相关性分析采用Spearman等级相关检验。应用二分类logistic回归分析的方法,建立HBV-ACLF的联合预测模型MELD-ICGR15、CTP-ICGR15。应用受试者工作特征(ROC)曲线下面积(AUC)来比较各种模型对HBV-ACLF患者短期预后判断的准确性,AUC的比较使用Medcalcdcal进行分析;根据ROC曲线各点对应的敏感度和特异度求得Youden指数的最大值,确定HBV-ACLF患者生存与否的最佳临界值(Medcalc)。结果CHB组与肝硬化组间比较,CTP(t=-3.245,P=0.002)、Alb(t=2.210,P=0.029)、ALT(Z=-2.572,P=0.010)、AST(Z=-1.993,P=0.046)差异均有统计学意义;肝硬化组的病死率为37.5%,高于CHB组的病死率17.54%(χ^2=4.893,P=0.027);肝硬化组腹膜炎的发生率为90%,明显高于CHB组的64.91%(χ^2=7.945,P=0.005)。CHB组中,ICGR15、MELD评分、CTP评分及TBil、Alb、PTA、PT、INR在死亡组和存活组之间差异均有统计学意义(t值分别为3.036、3.878、3.488、2.756、-3.049、-3.954、2.713、2.717,P值均<0.05);肝硬化组中,ICGR15、CTP评分、Alb在死亡组和存活组间差异均有统计学意义(t值分别为3.476、2.79、-2.274,P值均<0.05)。不管有无肝硬化基础,ICGR15与MELD评分(r值分别为0.483、0.350,P值均<0.05)、I
Objective To investigate the value of indocyanine green(ICG)clearance test in evaluating the short-term prognosis of patients with hepatitis B virus(HBV)-related acute-on-chronic liver failure(HBV-ACLF),to establish a new model for prognostic evaluation based on indocyanine green retention rate at 15 minutes(ICGR15)combined with Model for End-Stage Liver Disease(MELD)score and Child-Turcotte-Pugh(CTP)score,and to provide a basis for establishing an ideal model for the short-term prognosis of HBV-ACLF.Methods A total of 97 patients with HBV-ACLF who were admitted to Department of Infectious Diseases in The Affiliated Hospital of Southwest Medical University from June 2017 to January 2019 were enrolled and related clinical data were collected.According to the primary liver disease,these patients were divided into chronic hepatitis B(CHB)group and liver cirrhosis(LC)group;according to the outcome at 3-month follow-up,they were divided into death group and survival group.ICGR15,biochemical indices,and coagulation markers were measured at the time of confirmed diagnosis,and CTP and MELD scores were calculated.The t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups.The chi-square test was used for comparison of categorical data between groups,and a Spearman rank correlation analysis was used to investigate the correlation of ICGR15 with each variable.A binary logistic regression analysis was used to establish the combined predictive models of MELD-ICGR15 and CTP-ICGR15 for HBV-ACLF.The area under the receiver operating characteristic(ROC)curve(AUC)was used to compare the accuracy of these models in predicting the short-term prognosis of patients with HBV-ACLF,and the Medcalcdcal method was used for comparison of AUC.The maximum of Youden index(sensitivity+specificity-1)was calculated based on the sensitivity and misjudgment rate corresponding to each point on the ROC curve,and
作者
都泓莲
何鸿雁
肖慈君
王波
李烨
盛云建
邓存良
DU Honglian;HE Hongyan;XIAO Cijun;et al(Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China)
出处
《临床肝胆病杂志》
CAS
北大核心
2019年第12期2759-2764,共6页
Journal of Clinical Hepatology
基金
西南医科大学校级青年基金(2017-ZRQN-022)
