HBV相关慢加急性肝衰竭预后简易评分系统的建立

厉新妍; 黄淑琳; 方亮; 雷瑞祥; 柯伟民

doi:10.3969/j.issn.1001-5256.2014.10.006

HBV相关慢加急性肝衰竭预后简易评分系统的建立

DOI: 10.3969/j.issn.1001-5256.2014.10.006

1. 广州市第一人民医院感染科
2. 广州市华南师范大学数学科学学院
3. 广州市中山大学附属第三医院感染科

基金项目:

广州市医药卫生科技项目(201102A213093)；广东省医学科学技术研究基金(A2011472)；

详细信息

中图分类号: R575.3
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出版历程
- 收稿日期: 2014-03-17
- 出版日期: 2014-10-20

A simple scoring system for evaluating severity of HBV-related acute-on-chronic liver failure

Department of Infectious Diseases, Guangzhou First Municipal People's Hospital

Research funding:

摘要

摘要:
目的建立HBV相关慢加急性肝衰竭（HBV-ACLF）严重度简易评分系统。方法收集620例HBV-ACLF患者的临床资料,选择肝性脑病、血清肌酐、血清总胆红素、凝血酶原活动度、感染、肝脏大小、腹水液平等7个临床指标,应用统计学方法并结合临床实际,确定各指标从04分评分界点,并累计总分。据此建立模型并确定诊断界点,对此评分模型进行验证。结果对HBV-ACLF患者临床资料进行统计学分析,交互卡方检验确定各指标评分分值并建立模型。将500例患者分为生存组和死亡组。两组间评分差异有统计学意义（t=25.78,P<0.001）。受试者工作特征曲线（ROC曲线）下面积0.963,最佳临界值9.5,灵敏度0.98,特异度0.83。120例患者对其进行验证,≥10分预后差,病死率为84.3%,≤9分组预后好,病死率为3.5%。两组病死率比较差异有统计学意义（χ2=72.2,P<0.001）。结论本评分系统可用于HBV-ACLF预后评估,具有简易、敏感、客观的优点。
- 肝炎病毒,乙型 /
- 肝功能衰竭 /
- 预后
Abstract:
Objective To establish a simple scoring system for evaluating the severity of hepatitis B virus ( HBV) -related acute-on-chronic liver failure ( HBV-ACLF) . Methods A retrospective analysis was performed on the clinical data of 620 patients with HBV-ACLF who were divided into group I ( 500 patients) and group II ( 120 patients) . Seven clinical parameters, including hepatic encephalopathy, serum creatinine, prothrombin activity, serum total bilirubin, infection, dimension of liver, and maximum depth of ascites, were scored from 0-4 points for each patient according to the disease severity. The severity scoring system was established based on the total score of each patient in group I, with the cut-off point being determined. The established system was tested with group II. Results A severity scoring system was successfully developed based on chi-squared automatic interaction detector analysis of the total score of each patient in group I. There was a significant difference in the total score between the survival and death subgroups of the 500 patients ( t = 25. 78, P <0. 001) . The area under the ROC curve was 0. 963, suggesting a high validity of this scoring system. With the cut-off value of 9. 5, the sensitivity and specificity of this system were 0. 98 and 0. 83, respectively. The other 120 patients were divided into the poor prognosis ( score ≥10) and good prognosis subgroups ( score ≤9) based on the scoring system, with the mortality rates being 84.3% and 3.5%, respectively; there was a significant difference in mortality between the two subgroups ( χ2= 72. 2, P < 0. 001) . Conclusion This scoring system is simple, sensitive, and objective to evaluate the severity of HBV-ACLF.
- hepatitis B virus /
- liver failure /
- prognosis

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参考文献(12)

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