摘要
目的探讨布-加综合征并发上消化道出血短期预后的影响因素,评估血小板-白蛋白-胆红素(PALBI)评分对布-加综合征并发上消化道出血患者30 d内死亡的预测价值。方法回顾性分析2014年1月至2020年2月在郑州大学第一附属医院确诊的74例布-加综合征并发上消化道出血患者的临床资料,其中男性51例,女性23例,年龄(46.5±11.1)岁。根据30 d内是否死亡分为两组:死亡组(n=16)和生存组(n=58)。分析患者短期死亡的危险因素,并评估PALBI、白蛋白-胆红素(ALBI)、Child-Turcotte-Pugh(CTP)、终末期肝病模型(MELD)评分对患者短期预后的预测价值。绘制受试者工作特征(ROC)曲线,计算并比较曲线下面积。结果生存组和死亡组在白细胞、血小板、PALBI评分、PALBI分级、ALBI评分、CTP评分、MELD评分、肝性脑病方面差异有统计学意义(P<0.05)。多因素logistic回归分析显示,CTP评分≥10即CTP C级(OR=1.669,95%CI:1.048~2.661)和PALBI评分>-2.09即PALBI 3级(OR=5.245,95%CI:2.128~12.924)是影响患者30 d内死亡的独立因素。PALBI、ALBI、CTP及MELD评分的ROC曲线下面积分别为0.89、0.72、0.77、0.76,截断值分别为-1.92、-1.60、8.50、13.60。四种评分系统AUC两两比较,PALBI评分预测能力好于ALBI和CTP评分,差异有统计学意义(P<0.05)。结论PALBI评分对于布-加综合征并发上消化道出血患者短期预后评估有良好的预测价值,效果与MELD评分相当,但优于ALBI和CTP评分。
Objective To study the factors influencing short-term prognosis of patients with Budd-Chiari syndrome(B-CS)presenting with upper gastrointestinal bleeding and to assess the predictive value of platelet-albumin-bilirubin score(PALBI)on death within 30 d in these patients.Methods A retrospective study was conducted on 74 patients with B-CS who presented with upper gastrointestinal bleeding and were treated at the First Affiliated Hospital of Zhengzhou University from January 2014 to February 2020.There were 51 males and 23 females,with age of(46.5±11.1)years old.These patients were divided into the survival group(n=58)and the death group(n=16)according to the disease outcomes up to 30 d of follow-up.Factors influencing short-term deaths of these patients were analyzed,and the predictive values of PALBI,ALBI,CTP and MELD scores on short-term prognosis of the patients were assessed.The receiver operating characteristic(ROC)curves were plotted,and the areas under the curve(AUC)were calculated and compared.Results The differences between patients in the survival and death groups for white blood cell,platelet,PALBI score,PALBI classification,ALBI score,CTP score,MELD score,and presence or absence of hepatic encephalopathy were significantly different(all P<0.05).Multivariate logistic regression analysis showed that CTP score≥10 or CTP grade C(OR=1.669,95%CI:1.048-2.661),and PALBI score>-2.09 or PALBI grade 3(OR=5.245,95%CI:2.128-12.924)were independent risk factors for predicting death within 30 days.The areas under the ROC curves for PALBI,ALBI,CTP and MELD score were 0.89,0.72,0.77 and 0.76,with the cut-off values of-1.92,-1.60,8.50 and 13.60,respectively.The differences between the PALBI score and ALBI,CTP scores were significantly different(P<0.05).Conclusion The PALBI score showed a positive predictive value on short-term prognostic assessment of patients with B-CS presenting with upper gastrointestinal bleeding.It was comparable to the effect of the MELD score but was significantly better than the ALBI and CTP
作者
党晓卫
沈东启
李路豪
刘兆臣
李素新
王培举
杨净
张跃辉
Dang Xiaowei;Shen Dongqi;Li Luhao;Liu Zhaochen;Li Suxin;Wang Peiju;Yang Jing;Zhang Yuehui(Department of Hepatopancreatobiliary Surgery,the First Affiliated Hospital of Zhengzhou University,Budd-Chiari Syndrome Diagnosis and Treatment Center of Henan Province,Zhengzhou 450052,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2022年第4期264-269,共6页
Chinese Journal of Hepatobiliary Surgery
基金
河南省医学科技攻关计划省部共建项目(SB201901003)。
