摘要
目的探讨终末期肝病模型(MELD)评分系统联合血小板/白细胞比值(PWR)在预测HBV相关慢加急性肝衰竭(HBV-ACLF)短期预后中的价值。方法回顾性分析2014年6月—2019年6月苏州大学附属第一医院收治的123例HBV-ACLF患者的临床资料,根据其入院后90 d的预后分为生存组(n=53)和死亡组(n=70)。记录患者的年龄、性别及入院24 h内患者TBil、ALT、AST、GGT、ALP、SCr、Alb、前白蛋白(PAB)、INR、WBC、淋巴细胞计数(LY)、单核细胞计数(MO)、中性粒细胞计数(NE)、Hb、PLT,并计算PWR和MELD评分。计量资料2组间比较采用t检验或Mann-Whitney U检验,单因素及多因素二元logistic回归分析各因素与HBV-ACLF预后的关系,并建立MELD评分联合PWR的预测模型。绘制受试者工作特征曲线(ROC曲线),并计算约登指数、临界值、敏感度、特异度,比较单独MELD评分和MELD评分联合PWR的ROC曲线下面积(AUC),比较两者评价HBV-ACLF患者预后的价值。结果两组患者TBil、ALT、SCr、INR、WBC、MO、NE、Hb、PLT、PWR和MELD评分比较差异均有统计学意义(P值均<0.05)。单因素分析显示,TBil、SCr、INR、WBC、MO、NE、MELD评分对HBV-ACLF患者的预后有影响(P值均<0.05)。多因素分析显示,PWR(OR=0.883,95%CI:0.798~0.977,P=0.016)和MELD评分(OR=1.442,95%CI:1.225~1.698,P<0.001)为HBV-ACLF患者预后的独立影响因素。MELD评分联合PWR(AUC=0.895,95%CI:0.827~0.943)对HBV-ACLF患者预后的预测能力高于单独MELD评分(AUC=0.842,95%CI:0.765~0.902),差异有统计学意义(P<0.05)。结论MELD评分联合PWR可以提高MELD评分预测HBV-ACLF患者预后的预测效能。
Objective To investigate the value of Model for End-Stage Liver Disease(MELD)score combined with platelet-to-white blood cell ratio(PWR)in predicting the short-term prognosis of patients with hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF).Methods A retrospective analysis was performed for the clinical data of 123 HBV-ACLF patients who were admitted to The First Affiliated Hospital of Suzhou University from June 2014 to June 2019,and according to the prognosis on day 90 after admission,these patients were divided into survival group with 53 patients and death group with 70 patients.Related clinical data were recorded,including age,sex,and total bilirubin(TBil),alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transpeptidase(GGT),alkaline phosphatase(ALP),serum creatinine(SCr),Albumin(Alb),prealbumin(PAB),international normalized ratio(INR),white blood cell count(WBC),lymphocyte count(LY),monocyte count(MO),neutrophil count(NE),hemoglobin(Hb),and platelet count(PLT)within 24 hours after admission,and PWR and MELD score were calculated.The t-test and the Mann-Whitney U test were used for comparison of continuous data between two groups;univariate and multivariate binary logistic regression analyses were used to analyze the association between each factor and the prognosis of HBV-ACLF;a predictive model of MELD score combined with PWR was established.The receiver operating characteristic(ROC)curve was plotted,and Youden index,cut-off value,sensitivity,and specificity were calculated;the area under the ROC curve(AUC)was calculated for MELD score alone or combined with PWR to compare their value in predicting the prognosis of HBV-ACLF patients.Results There were significant differences between the two groups in TBil,ALT,SCr,INR,WBC,MO,NE,Hb,PLT,PWR,and MELD score(all P<0.05).TBil,SCr,INR,WBC,MO,NE,and MELD score were risk factors for prognosis of HBV-ACLF patients(all P<0.05);PWR(odds ratio[OR]=0.883,95%confidence interval[CI]:0.798-0.977,P=0.016)and MELD score(OR=1.442
作者
高心怡
陈丽
甘建和
GAO Xinyi;CHEN Li;GAN Jianhe(Department of Infectious Diseases, The First Affiliated Hospital of Suzhou University, Suzhou, Jiangsu 215000, China)
出处
《临床肝胆病杂志》
CAS
北大核心
2021年第5期1070-1074,共5页
Journal of Clinical Hepatology
基金
国家科技部“十三五”重大专项(2017ZX10203201)。
