MELD 评分体系联合ALB 检测对HBV-ACLF 患者预后评估的价值

Value of model for end-stage liver disease score combined with albumin detection in evaluating prognosis of patients with HBV-related acute-on-chronic liver failure

摘要:

目的 探讨终末期肝病模型（MELD）评分联合白蛋白（ALB）对乙型肝炎病毒相关慢加急性 肝衰竭（HBV-ACLF）3 个月预后的预测价值。方法 回顾性分析2014 年6 月—2018 年2 月西南医科大学 附属医院收治的251 例HBV-ACLF 患者，依据3 个月患者的预后分为存活组152 例和死亡组99 例。入院 24 h 内收集患者的一般临床资料，同时进行MELD 评分。比较两组患者一般资料间的差异，采用多因素二分 类Logistic 回归分析各因素与HBV-ACLF 患者预后的关系。通过绘制受试者工作特征（ROC）曲线，分析 MELD 评分联合ALB 的ROC 曲线下面积（AUC），取预测指数（Youden 指数）最大时的截断值、敏感性、 特异性、阳性似然比及阴性似然比，评价两者联合与独立MELD 评分预测HBV-ACLF 患者3 个月预后的 价值。结果 死亡组年龄、总胆红素（TBIL）、肌酐（Cr）、国际标准化比值（INR）及MELD 评分高于存 活组，而凝血酶原活动度（PTA）、白蛋白（ALB）低于存活组（P <0.05）；年龄、MELD 评分为预测HBVACLF 患者预后的危险因素（P <0.05），而PTA 和ALB 为预测HBV-ACLF 患者预后的保护性因素（P <0.05）； MELD 评分联合ALB 的AUC 高于独立MELD 评分。结论 MELD 评分联合ALB 对预测HBV-ACLF 患者 3 个月预后情况较独立MELD 评分有更高的预测价值。

Abstract:

Objective To observe the value of MELD scoring system combined with albumin (ALB, albumin) in predicting the 3-month prognosis of HBV-related acute-on-chronic liver failure (HBV-ACLF). Methods A retrospective analysis of 251 patients with HBV-ACLF admitted to our department from June 2014 to February 2018 was divided into survival group (n = 152) and death group (n = 99) according to the prognosis of 3 months. The data including demography, liver and kidney function and coagulation were collected within 24 hours of admission to MELD. The t-test was used to compare the difference of data between the two groups, and multivariate classification Logistic regression analysis was used to analyze the relationship between the related factors and the prognosis of HBV-ACLF patients. By the receiver operating characteristic curve (ROC curve) of subjects, the area under the ROC curve of MELD score combined with ALB, the predicted index (Youden index), the truncation value, sensitivity, specificity, positive likelihood ratio and negative likelihood ratio, the value of combined and independent MELD score in predicting 3-month prognosis of patients with HBV-ACLF was evaluated. Results Compared with the survival group, age, total bilirubin (TBIL), creatinine (Cr), international normalized ratio (INR) and MELD score were higher in the death group , but prothrombin time activity (PTA) and serum albumin (ALB) were significantly lower (all P < 0.05); Age and MELD score were the risk factors for predicting the prognosis of HBV-ACLF patients (all P < 0.05), while PTA and ALB were protective factors (all P < 0.05); MELD score combined with ALB had a higher AUC than independent MELD score. Conclusions MELD score combined with ALB has higher predictive value than independent MELD score in predicting 3-month prognosis of HBV-ACLF patients.