摘要
目的探讨Child-Pugh评分、终末期肝病模型(MELD)评分、联合血清钠离子的终末期肝病模型(MELD-Na)评分、慢性肝衰竭联盟-急性失代偿(CLIF-C AD)评分和经颈静脉肝内门体分流术(TIPS)术后生存Freiburg指数(FIPS)评分对肝硬化患者生存的预测价值。方法回顾性分析2014年1月—2021年2月我国西南地区多家医院行TIPS治疗的447例肝硬化患者的临床资料,其中生存组306例,死亡组62例。计算五种评分模型分值,并基于五种评分模型分别对患者进行生存分析。正态分布的计量资料组间比较采用独立样本的t检验;不符合正态分布的计量资料组间比较采用非参数Mann-Whitney U检验;计数资料组间比较采用Pearsonχ^(2)检验;采用Cox回归分析各评分模型对TIPS患者预后的影响;Kaplan-Meier法分析不同评分水平的患者死亡风险的差异,并采用Log-rank检验。各模型预测能力采用受试者工作特征曲线下面积(AUC)、不同时间点C指数及决策曲线进行评估。结果生存组患者年龄(Z=2.884)低于死亡组,Alb(t=3.577)、Na^(+)(Z=-3.756)均高于死亡组,而酒精性肝硬化患者比例(χ^(2)=22.674)、AST(Z=2.141)、PT(Z=2.486)、INR(Z=2.429)、TBil(Z=3.754)、腹水严重程度(χ^(2)=14.186)及五种模型评分均低于死亡组(P值均<0.05)。生存分析显示,各评分模型均能有效对TIPS患者预后进行风险分层。对各评分模型不同时间点C指数比较发现,Child-Pugh评分对术后生存预测能力较高,其次为MELD-Na评分、MELD评分和CLIF-C AD评分,而FIPS评分预测能力相对较差,此外,随时间延长,各评分预测效能均减弱。Child-Pugh评分术后1年生存率的预测效能最大(AUC=0.832),MELD-Na评分术后3年生存率的预测效能最大(AUC=0.726),而FIPS评分术后在1年和3年生存预测能力比较中均较差。结论五种评分模型均可作为肝硬化TIPS术后患者生存的预测方法,且都可为肝硬化TIPS患者提供有效的预后风险分层。
Objective To compare the value of Child-Pugh score,Model for End-Stage Liver Disease(MELD)score,MELD combined with serum sodium concentration(MELD-Na)score,CLIF Consortium Acute Decompensation(CLIF-C AD)score,and Freiburg index of post-transjugular intrahepatic portosystemic shunt(TIPS)survival(FIPS)score in predicting the survival of patients undergoing TIPS.Methods A retrospective analysis was performed for the clinical data of 447 patients with liver cirrhosis who underwent TIPS in several hospitals in southwest China,among whom there were 306 patients in the survival group and 62 in the death group.The scores of the above five models were calculated,and a survival analysis was performed based on these models.The independent samples t-test was used for comparison of normally distributed continuous data between groups,and the non-parametric Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups;the Pearson chi-square test was used for comparison of categorical data between groups;a multivariate Cox regression analysis was used for correction analysis of known influencing factors with statistical significance which were not included in the scoring models;the Kaplan-Meier method was used to evaluate the discriminatory ability of each model in identifying risks in the surgical population,and the log-rank test was used for analysis.The area under the receiver operating characteristic curve(AUC),C-index at different time points,and calibration curve were used to evaluate the predictive ability of each scoring model.Results Compared with the death group,the survival group had significantly lower age(Z=2.884,P<0.05),higher albumin(t=3.577,P<0.05),and Na^(+)(Z=-3.756,P<0.05)and significantly lower proportion of patients with alcoholic cirrhosis(χ^(2)=22.674,P<0.05),aspartate aminotransferase(Z=2.141,P<0.05),prothrombin time(Z=2.486,P<0.05),international normalized ratio(Z=2.429,P<0.05),total bilirubin(Z=3.754,P<0.05),severity of ascites(χ^(2)=14.186,P<0.05),and scores o
作者
刘钰懿
慕之勇
胡辂
王军
熊伟
胡鸿
刘爱民
安选
许愈强
余灏东
王金能
文良志
陈东风
LIU Yuyi;MU Zhiyong;HU Lu;WANG Jun;XIONG Wei;HU Hong;LIU Aimin;AN Xuan;XU Yuqiang;YU Haodong;WANG Jinneng;WEN Liangzhi;CHEN Dongfeng(Department of Gastroenterology,Chongqing Key Laboratory of Digestive Malignancies,Army Specialized Medical Center of Army Medical University&Daping Hospital,Chongqing400042,China;Department of Gastroenterology,The Third Affiliated Hospital of Chongqing Medical University,Chongqing 400042,China;Department of Interventional Radiology,Nanchong Central Hospital,North Sichuan Medical College,Nanchong,Sichuan 637000,China;Department of Gastroenterology,Chongqing University Fuling Hospital,Chongqing 408000,China;Department of Hepatology,Chongqing University Three Gorges Hospital,Chongqing 404100,China;Department of Gastroenterology,The People’s Hospital of Leshan,Leshan,Sichuan 614000,China;Department of Gastroenterology,Chongqing University Qianjiang Hospital,Chongqing 409000,China;Department of Gastroenterology,The Ninth People’s Hospital of Chongqing,Chongqing 400042,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2023年第3期590-598,共9页
Journal of Clinical Hepatology
基金
国家自然科学基金(82170594)。
关键词
肝硬化
门静脉高压
门体分流术
经颈静脉肝内
Liver Cirrhosis
Portal Hypertension
Portasystemic Shunt,Transjugular Intrahepatic
