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MELD评分联合血小板/白细胞比值对HBV相关慢加急性肝衰竭患者预后的预测价值

高心怡 陈丽 甘建和

引用本文:
Citation:

MELD评分联合血小板/白细胞比值对HBV相关慢加急性肝衰竭患者预后的预测价值

DOI: 10.3969/j.issn.1001-5256.2021.05.019
基金项目: 

国家科技部“十三五”重大专项 (2017ZX10203201)

利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
作者贡献声明:高心怡负责提出研究选题,设计研究方案,实施研究过程,采集整理数据,起草论文; 陈丽负责调研整理文献,设计论文框架,起草论文,修订论文,终审论文;甘建和负责统计分析,获取研究经费,技术或材料支持,指导性支持。
详细信息
    作者简介:

    高心怡(1994—),女,主要从事肝炎、肝硬化、肝衰竭及感染性疾病的临床与基础研究

    通信作者:

    甘建和,ganjianhe@aliyun.com

  • 中图分类号: R512.62

Value of Model for End-Stage Liver Disease score combined with platelet-to-white blood cell ratio in predicting the prognosis of patients with hepatitis B virus-associated acute-on-chronic liver failure

  • 摘要:   目的  探讨终末期肝病模型(MELD)评分系统联合血小板/白细胞比值(PWR)在预测HBV相关慢加急性肝衰竭(HBV-ACLF)短期预后中的价值。  方法  回顾性分析2014年6月—2019年6月苏州大学附属第一医院收治的123例HBV-ACLF患者的临床资料,根据其入院后90 d的预后分为生存组(n=53)和死亡组(n=70)。记录患者的年龄、性别及入院24 h内患者TBil、ALT、AST、GGT、ALP、SCr、Alb、前白蛋白(PAB)、INR、WBC、淋巴细胞计数(LY)、单核细胞计数(MO)、中性粒细胞计数(NE)、Hb、PLT,并计算PWR和MELD评分。计量资料2组间比较采用t检验或Mann-Whitney U检验,单因素及多因素二元logistic回归分析各因素与HBV-ACLF预后的关系,并建立MELD评分联合PWR的预测模型。绘制受试者工作特征曲线(ROC曲线),并计算约登指数、临界值、敏感度、特异度,比较单独MELD评分和MELD评分联合PWR的ROC曲线下面积(AUC),比较两者评价HBV-ACLF患者预后的价值。  结果  两组患者TBil、ALT、SCr、INR、WBC、MO、NE、Hb、PLT、PWR和MELD评分比较差异均有统计学意义(P值均<0.05)。单因素分析显示,TBil、SCr、INR、WBC、MO、NE、MELD评分对HBV-ACLF患者的预后有影响(P值均<0.05)。多因素分析显示,PWR(OR=0.883, 95%CI: 0.798~0.977, P=0.016)和MELD评分(OR=1.442, 95%CI: 1.225~1.698, P<0.001)为HBV-ACLF患者预后的独立影响因素。MELD评分联合PWR(AUC=0.895,95%CI:0.827~0.943)对HBV-ACLF患者预后的预测能力高于单独MELD评分(AUC=0.842,95%CI:0.765~0.902),差异有统计学意义(P<0.05)。  结论  MELD评分联合PWR可以提高MELD评分预测HBV-ACLF患者预后的预测效能。

     

  • 图  1  MELD联合PWR的ROC曲线

    表  1  两组患者一般资料比较

    指标 生存组(n=53) 死亡组(n=70) 统计值 P
    年龄(岁) 47.81±14.66 52.34±11.84 t=-1.897 0.112
    TBil(μmol/L) 287.80(231.10~368.65) 350.60(257.83~457.40) Z=-2.316 0.021
    ALT(U/L) 472.00(227.50~889.55) 247.20(59.45~728.00) Z=-2.155 0.031
    AST(U/L) 275.00(124.55~626.20) 210.60(92.75~520.50) Z=-0.950 0.342
    GGT(U/L) 99.40(65.50~142.05) 81.50(51.50~123.88) Z=-1.785 0.074
    ALP(U/L) 127.70(108.50~163.05) 137.00(104.30~164.23) Z=-0.020 0.984
    SCr(μmol/L) 58.00(49.70~66.00) 70.00(53.50~111.38) Z=-3.210 0.001
    Alb(g/L) 32.17±4.11 30.58±5.30 t=1.818 0.231
    PAB(mg/L) 39.20(28.70~59.00) 41.45(28.90~64.60) Z=-0.444 0.657
    INR 1.81(1.68~2.02) 2.56(2.01~3.22) Z=-5.480 <0.001
    WBC(109/L) 5.92(4.47~8.02) 9.48(6.42~12.07) Z=-4.446 <0.001
    LY(109/L) 1.01(0.75~1.47) 0.92(0.61~1.24) Z=-1.918 0.055
    MO(109/L) 0.42(0.29~0.65) 0.61(0.35~0.90) Z=-2.541 0.011
    NE(109/L) 4.21(2.97~5.77) 7.49(4.63~10.29) Z=-4.334 <0.001
    Hb(g/L) 132(115~148) 120(87~141) Z=-2.166 0.018
    PLT(109/L) 100(76~129) 80(45~110) Z=-2.745 0.006
    PWR 16.57(11.35~23.59) 8.97(4.64~15.12) Z=-4.985 <0.001
    MELD评分 20.18(18.17~22.06) 26.57(22.52~30.93) Z=-6.481 <0.001
    下载: 导出CSV

    表  2  单因素logistics分析

    指标 OR 95%CI P
    TBil 1.004 1.001~1.007 0.017
    ALT 1.000 0.999~1.000 0.718
    SCr 1.032 1.013~1.051 0.001
    INR 6.119 2.669~14.025 <0.001
    WBC 1.226 1.096~1.372 <0.001
    MO 2.731 1.031~7.230 0.043
    NE 1.282 1.126~1.458 <0.001
    Hb 0.983 0.970~0.996 0.010
    PLT 0.994 0.987~1.000 0.067
    PWR 0.870 0.819~0.925 <0.001
    MELD评分 1.386 1.217~1.578 <0.001
    下载: 导出CSV

    表  3  MELD评分及MELD评分联合PWR预测HBV-ACLF患者预后的ROC曲线

    指标 AUC 约登指数 临界值 敏感度(%) 特异度(%)
    MELD评分 0.842 0.593 22.315 80.00 79.25
    MELD评分联合PWR 0.895 0.696 0.507 77.14 92.45
    下载: 导出CSV
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