摘要
目的探讨MELD评分联合氨基末端脑钠肽前体(NT-Pro-BNP)预测肝硬化门脉高压食管胃静脉曲张出血患者出血后3个月预后的临床价值。方法选取2016年1月至2018年6月于杭州市西溪医院入住ICU的肝硬化食管胃曲张静脉出血患者97例,以3个月为观察期,分为生存组(78例)和死亡组(19例),比较两组患者出血后24 h时的血清总胆红素、肌酐、国际标准化比值、血清钠、MELD评分和NT-Pro-BNP。受试者工作特征曲线下面积(AUC)分析MELD评分联合NT-Pro-BNP的诊断价值。结果死亡组患者消化道出血后24h的总胆红素98.0(39.4,112.5)μmol/L高于生存组33.1(17.8,66.2)μmol/L,国际标准化比值1.9(1.4,2.0)高于生存组1.4(1.2,1.7),MELD评分17.0(16.8,22.0)高于生存组13.0(10.8,17.5),NT-Pro-BNP 770.0(454.0,3347.0)pg/mL高于生存组329.0(93.0,693.0)pg/mL,差异有统计学意义(Z=-2.782、-2.696、-3.591、-3.559,P<0.05)。MELD评分、NT-pro-BNP预测肝硬化食管胃静脉曲张破裂出血患者近期死亡危险性的最佳临界值分别为14.5和448.5 pg/mL。MELD评分联合NT-pro-BNP判断肝硬化食管胃静脉曲张出血患者短期预后的AUC为0.836,高于单独MELD评分的0.766和NT-pro-BNP的0.821。结论MELD评分联合NT-Pro-BNP对预测肝硬化食管胃静脉曲张出血患者短期预后的预测价值良好。
Objective To investigate the predictive value of combined model for MELD score and serum N-terminal brain natriuretic pro-peptide(NT-Pro-BNP)on the 3-month prognosis of cirrhosis patients with bleeding esophageal varices.Methods A total of 97 cirrhosis patients with bleeding esophageal varices from January 2016 to June 2018 in Xixi Hospital were respectively analyzed,and divided into survival group(78 cases)and death group(19 cases)according to the prognosis by 3-month follow-up.Serum TBil,creatinine(Cr),international normalized ratio(INR),Na,MELD score and serum NT-Pro-BNP were measured 24 h after bleeding and compared between the two groups.The capability of MELD score combined with serum NT-Pro-BNP was evaluated by area under curve(AUC).Results In death group,serum levels of TBil,INR,MELD score and NT-Pro-BNP were 98.0(39.4,112.5)μmol/L,1.9(1.4,2.0),17.0(16.8,22.0)and 770.0(454.0,3347.0)pg/mL,which were all higher than those in survival group of 33.1(17.8,66.2)μmol/L,1.4(1.2,1.7),13.0(10.8,17.5)and 329.0(93.0,693.0)pg/mL(Z=-2.782,-2.696,-3.591,-3.559,P<0.05).The optimal cut-off value of MELD score and serum level of NT-Pro-BNP in predicting short-term mortality of cirrhosis patients with bleeding esophageal varices were 14.5 and 448.5 pg/mL.The AUC of combined MELD score and NT-Pro-BNP was 0.836,which was higher than that of single MELD score(0.766)or NT-Pro-BNP(0.821),respectively.Conclusions MELD score combined with serum NT-Pro-BNP has a good predictive value for the short-term prognosis in cirrhosis patients with bleeding esophageal varices.
作者
周可幸
张思泉
刘华锋
韩加裕
赵曦
Zhou Kexing;Zhang Siquan;Liu Huafeng;Han Jiayu;Zhao Xi(Intensive Care Unit,Xixi Hospital,Hangzhou 310023,China;Medical Records Department,Xixi Hospital,Hangzhou 310023,China)
出处
《国际流行病学传染病学杂志》
CAS
2019年第6期505-508,共4页
International Journal of Epidemiology and Infectious Disease
基金
浙江省医药卫生科技计划(2019KY531)。
关键词
肝硬化
静脉曲张
MELD评分
氨基末端脑钠肽前体
预后
Liver cirrhosis
Varicose veins
Model for end-stage liver disease score
NT-Pro-BNP
Prognosis
