摘要
目的探讨还原型谷胱甘肽联合PE+DPMAS对慢加急性肝衰竭(ACLF)患者肝功能的影响及预后评分模型的建立。方法回顾性选择2018年5月至2021年5月南通市第三人民医院确诊的84例ACLF患者,随机分为PE+DPMAS组(A组)和还原型谷胱甘肽+PE+DPMAS组(B组),每组各42例。记录患者6个月的生存状态,然后将B组分为生存组与死亡组。进行两组基线资料比较,两组治疗3个月的肝功能指标、临床疗效对比。分析6个月生存影响因素;建立6个月生存预测ROC模型。结果B组INR为1.82(1.48~2.20),A组2.18(1.52~2.87)(Z=-4.350,P=0.003);B组Cr水平为0.63(0.40~0.71),A组0.78(0.62~0.85)(Z=-2.256,P=0.006);B组MELD评分为23.69(17.85~27.02),A组24.67(22.37~28.86)(Z=-5.307,P<0.001);B组MELD-Na评分21.25(16.69~29.95),A组25.66(21.84~31.67)(Z=-4.892,P<0.001)。治疗3个月后,B组AST水平为(42.11±9.85)U/L,A组(68.02±13.79)U/L(t=9.909,P<0.001);B组TBil水平为(21.55±6.32)μmol/L,A组(32.77±6.09)μmol/L(t=8.285,P<0.001);B组γ-GT水平为(32.55±9.07)U/L,A组(78.05±15.79)U/L(t=16.193,P<0.001);B组ALT水平为(45.38±10.73)U/L,A组(78.05±15.79)(t=7.589,P<0.001)。两组患者均未发生死亡,B组治疗总有效率(92.86%)明显高于A组(76.19%)(χ^(2)=4.459,P<0.05)。根据患者6个月生存情况,将B组患者分为生存组(25例)与死亡组(17例)。COX多因素分析显示,年龄(OR=1.013,95%CI:1.102~1.03)、TBil(OR=1.003,95%CI:1.024~1.085)、INR(OR=1.101,95%CI:1.132~2.387)、PLT(OR=1.008,95%CI:1.092~1.101)是患者生存的独立危险因素。依据COX结果,建立B组治疗的肝衰竭预后预测模型(A模型)。在ROC曲线中,A模型预测的AUC为0.752(95%CI:0.660~0.845),大于MELD评分模型(0.662,95%CI:0.557~0.768)和MELD-Na评分模型(0.702,95%CI:0.605~0.799)。结论还原型谷胱甘肽联合PE+DPMAS能明显促进患者肝功能恢复,年龄、TBil、INR和PLT是患者生存独立危险因素,新模型对患者生存预测效能明显优于传统MELD评分和MELD-Na评分模型。
Objective To explore the effect of reduced glutathione combined with plasma exchange and double plasma molecular absorb system(PE+DPMAS)on liver function of patients with acute-on-chronic liver failure and establish a prognostic scoring model.Methods A total of 84 patients with acute-on-chronic liver failure diagnosed from May 2018 to May 2021 were retrospectively selected.The patients were randomly divided into PE+DPMAS group(group A)and reduced glutathione+PE+DPMAS group(group B),with 42 cases in each group.The 6-month survival status of the patients was recorded.The patients in Group B were further divided into a survival group and a death group.The baseline data,liver function indexes and clinical efficacy after 2 months of treatment between these two groups were compared.The influencing factors of six-month survival were analyzed.The ROC model for predicting 6-month survival was established.Results The INR of group B and group A was 1.82(1.48-2.20)and 2.18(1.52-2.87),respectively(Z=-4.350,P=0.003);the level of Cr in group B and group A was 0.63(0.40-0.71)and 0.78(0.62~0.85),respectively(Z=-2.256,P=0.006);MELD score of group B and group A was 23.69(17.85~27.02)and 24.67(22.37~28.86),respectively(Z=-5.307,P<0.001);The MELD-Na score of group B and group A was 21.25(16.69-29.95),and 25.66(21.84-31.67),respectively(Z=-4.892,P<0.001).After 3 months of treatment,the AST level of group B and group A was 42.11±9.85 and 68.02±13.79,respectively(t=9.909,P<0.001);the level of TBIL in group B and group A was 21.55±6.32 and 32.77±6.09,respectively(t=8.285,P<0.001);γ-GT level in group B and group A was 32.55±9.07 and 78.05±15.79,respectively(t=16.193,P<0.001);the ALT level in group B and group A was 45.38±10.73 and 78.05±15.79,respectively(t=7.589,P<0.001).There was no death in both groups,and the total effective rate of 92.86%in group B was significantly higher than that of 76.19%in group A(χ^(2)=4.459,P<0.05).According to the 6-month survival,patients in group B were divided into a survival group(25 cases)and a
作者
许海玲
章颖
俞冲
王忠成
陈琳
XU Hai-ling;ZHANG Ying;YU Chong;WANG Zhong-cheng;CHEN Lin(Department of Liver Disease 1,Nantong Third People’s Hospital,Affiliated Nantong Hospital 3 of Nantong University,Jiangsu 226006,China;Department of Critical Infection,Nantong Third People’s Hospital、Affiliated Nantong Hospital 3 of Nantong University,Jiangsu 226006,China;Department of Integrated Chinese and Western medicine Hepatology,Nantong Third People’s Hospital、Affiliated Nantong Hospital 3 of Nantong University,Jiangsu 226006,China;Institute of Liver Diseases,Nantong Third People’s Hospital、Affiliated Nantong Hospital 3 of Nantong University,Jiangsu 226006,China)
出处
《肝脏》
2023年第3期334-339,共6页
Chinese Hepatology
基金
江苏省卫健委科研项目(Z2020011)
南通市科技局科研基金项目(MSZ20099)
南通市卫计委局青项目(MB2020038)。
