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PALBI评分对肝硬化合并急性上消化道出血患者短期预后的预测价值

徐陈 蒋淼

徐陈, 蒋淼. PALBI评分对肝硬化合并急性上消化道出血患者短期预后的预测价值[J]. 临床肝胆病杂志, 2021, 37(7): 1578-1581. DOI: 10.3969/j.issn.1001-5256.2021.07.020
引用本文: 徐陈, 蒋淼. PALBI评分对肝硬化合并急性上消化道出血患者短期预后的预测价值[J]. 临床肝胆病杂志, 2021, 37(7): 1578-1581. DOI: 10.3969/j.issn.1001-5256.2021.07.020
XU C, JIANG M. Value of platelet-albumin-bilirubin score in predicting the short-term prognosis of patients with liver cirrhosis and acute upper gastrointestinal bleeding[J]. J Clin Hepatol, 2021, 37(7): 1578-1581. DOI: 10.3969/j.issn.1001-5256.2021.07.020
Citation: XU C, JIANG M. Value of platelet-albumin-bilirubin score in predicting the short-term prognosis of patients with liver cirrhosis and acute upper gastrointestinal bleeding[J]. J Clin Hepatol, 2021, 37(7): 1578-1581. DOI: 10.3969/j.issn.1001-5256.2021.07.020

PALBI评分对肝硬化合并急性上消化道出血患者短期预后的预测价值

DOI: 10.3969/j.issn.1001-5256.2021.07.020
详细信息
    通讯作者:

    蒋淼,jiangmiao1978@163.com

  • 中图分类号: R575.2

Value of platelet-albumin-bilirubin score in predicting the short-term prognosis of patients with liver cirrhosis and acute upper gastrointestinal bleeding

  • 摘要:   目的  评估血小板-白蛋白-胆红素评分(PALBI)对肝硬化合并急性上消化道出血患者30 d内死亡的预测价值。  方法  回顾性收集2016年1月—2020年2月在复旦大学附属金山医院因急性上消化道出血入院的211例肝硬化患者,根据30 d内生存情况分为死亡组(n=24)和生存组(n=187),收集患者的流行病学资料(年龄、性别等)和实验室检查资料(血常规、肝肾功能、凝血功能等),计算入院时的PALBI、ALBI、CTP和MELD评分,比较两组间评分是否存在差异。计量资料两组间比较采用t检验;计数资料两组间比较采用χ2检验。通过受试者工作特征曲线(ROC曲线)及曲线下面积(AUC)衡量模型的预测能力。AUC的比较采用DeLong检验。  结果  死亡组PALBI、ALBI、CTP和MELD评分分别为-1.47± 0.35、-0.74±0.49、10.25±1.98、17.25±4.68,生存组PALBI、ALBI、CTP和MELD分值分别为-1.94±0.36、-1.38±0.51、8.06±1.70、11.63±4.83,死亡组各项评分均明显高于生存组(P值均<0.001)。PALBI、ALBI、CTP和MELD评分的ROC曲线下面积分别为0.827、0.824、0.790、0.811,AUC两两比较差异均无统计学意义(P值均>0.05)。  结论  PALBI评分对肝硬化合并急性上消化道出血30 d内死亡的预测表现良好,与CTP和MELD评分相当。

     

  • 图  1  四种评分预测肝硬化合并上消化道出血患者30 d内死亡的ROC曲线

    表  1  CTP评分计算方式[7]

    指标 1分 2分 3分
    总胆红素(μmol/L) <34 34~51 >51
    白蛋白(g/L) >35 28~35 <28
    凝血酶原时间延长(s) <4 4~6 >6
    腹水 轻度 中度
    肝性脑病(级) 1~2 3~4
    下载: 导出CSV

    表  2  死亡组与生存组一般情况及生化指标比较

    指标 死亡组(n=24) 生存组(n=187) 统计值 P
    男/女(例) 16/8 100/87 χ2=1.495 0.221
    年龄(岁) 68.96±16.95 68.42±12.68 t=0.151 0.881
    休克指数(心率/收缩压) 0.88±0.29 0.77±0.21 t=1.834 0.078
    合并原发性肝细胞癌[例(%)] 5(20.8) 44(23.5) χ2=0.087 0.768
    合并糖尿病[例(%)] 7(29.2) 51(27.3) χ2=0.038 0.845
    红细胞计数(×1012/L) 2.50±0.67 2.66±0.82 t=-0.908 0.365
    血红蛋白(g/L) 82.3±27.5 76.2±20.0 t=1.035 0.310
    胃镜检查[例(%)] 16(66.7) 140(74.9)
      有门静脉高压性出血 13(81.3) 110(78.6)
      无门静脉高压性出血 3(18.7) 30(21.4)
    下载: 导出CSV

    表  3  两组四种评分的比较

    评分类型 死亡组(n=24) 生存组(n=187) t P
    PALBI评分 -1.47±0.35 -1.94±0.36 6.138 <0.001
      1级[例(%)] 0 5(2.7)
      2级[例(%)] 1(4.2) 56(29.9)
      3级[例(%)] 23(95.8) 126(67.4)
    ALBI评分 -0.74±0.49 -1.38±0.51 5.850 <0.001
      1级[例(%)] 0 1(0.5)
      2级[例(%)] 2(8.3) 91(48.7)
      3级[例(%)] 22(91.7) 95(50.8)
    CPT评分 10.25±1.98 8.06±1.70 5.799 <0.001
      A级[例(%)] 1(4.2) 35(18.7)
      B级[例(%)] 6(25) 118(63.1)
      C级[例(%)] 17(70.8) 34(18.2)
    MELD评分 17.25±4.68 11.63±4.83 5.381 <0.001
    下载: 导出CSV

    表  4  四种评分系统预测肝硬化合并上消化道出血患者30天内死亡的ROC曲线结果

    评分类型 AUC(95%CI) 最佳截断值 敏感度(%) 特异度(%)
    PALBI评分 0.827(0.739~0.915) -1.535 66.7 87.7
    ALBI评分 0.824(0.740~0.908) -0.855 66.7 85.0
    CTP评分 0.790(0.683~0.898) 9.5 70.8 81.8
    MELD评分 0.811(0.725~0.897) 14.5 79.2 77.5
    下载: 导出CSV
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  • 收稿日期:  2021-01-30
  • 修回日期:  2021-03-17
  • 刊出日期:  2021-07-20
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