甲胎蛋白和胆碱酯酶在肝衰竭临床结局预测中的应用价值探讨

Value of AFP and ChE in predicting clinical outcome of liver failure

摘要:

目的 探讨甲胎蛋白（AFP）和胆碱酯酶（ChE）在肝衰竭临床结局中的应用价值。方法 选取中国医科大学附属盛京医院179例肝衰竭患者，根据患者离院时状态分为生存组及死亡组。收集患者肝衰竭相关实验室指标并进行比较，通过Logistic多因素回归分析筛选影响肝衰竭临床结局的危险因素。使用受试者操作特征（ROC）曲线分析相关指标对肝衰竭临床结局的预测能力。结果 多因素Logistic回归发现国际标准化比值（INR）[OlR=4.393，（95% CI：2.174，8.879）]、白蛋白（Alb）[OlR=1.956，（95% CI：1.184，3.231）]、 甲胎蛋白（AFP）[OlR=1.371，（95% CI：1.075，1.748）]和胆碱酯酶（ChE）[OlR=5.276，（95% CI：3.586，7.762）]是影响肝衰竭预后的危险因素。AFP预测肝衰竭预后的曲线下面积（AUC）为0.808，敏感性为86.6% （95% CI：78.2%，92.7%），特异性为63.4%（95% CI：52.0%，73.8%）；ChE预测肝衰竭预后的AUC为0.802，敏感性为53.6%（95% CI：43.2%，63.8%），特异性为92.7%（95% CI：84.8%，97.3%）。两者联合的AUC为0.872，高于 两者单独预测的准确性（AFP：Z?=3.084，P?=0.002；ChE：Z?=2.945，P?=0.003），其敏感性为84.5%（95% CI：75.8%，91.1%），特异性为76.8%（95% CI：66.2%，85.4%）。结论 AFP及ChE可用于预测肝衰竭患者临床结局，两者联合可以对肝衰竭临床结局作出较为准确的预测。

Abstract:

Objective To explore the value of alpha fetal protein (AFP) and cholinesterase (ChE) in predicting clinical outcome of liver failure. Method A total of 179 patients with liver failure in our hospital was recruited. They were divided into the survival group and the death group according to the condition of the patients leaving the hospital. The laboratory index related to liver failure of two groups were collected. Multivariate Logistic regression analysis was used to explore the risk factors of clinical outcome of liver failure. ROC curves were used to evaluate the predictive ability of relevant indicators for clinical outcomes of liver failure. Results Multivariate logistic regression found that AFP [OlR?=?1.371, (95% CI: 1.075, 1.748)], ChE [OlR?=?5.276, (95% CI: 3.586, 7.762)], international normalized ratio (INR) [OlR?=?4.393, (95% CI: 2.174, 8.879)], and albumin (ALB) [OlR?=?1.956, (95% CI: 1.184, 3.231)] were independent factors influencing the prognosis of liver failure, and the differences were statistically significant (P?