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COSSH-ACLFs评分模型对HBV相关慢加急性肝衰竭患者短期预后的预测价值
Value of the COSSH-ACLFs model in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure
文章发布日期:2020年06月01日  来源:  作者:田小利,吴松林,王波,等  点击次数:190次  下载次数:37次

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【摘要】:目的 探讨COSSH-ACLFs评分模型预测HBV相关慢加急性肝衰竭(HBV-ACLF)患者短期(90 d)预后的价值。方法 纳入2014年1月-2019年10月西南医科大学附属医院、2017年1月-2018年12月内江市第一人民医院及宜宾市第二人民医院确诊的HBV-ACLF患者573例,收集患者的一般资料及相关实验室检查指标。根据确诊后90 d患者的生存情况分为生存组(n=339)和死亡组(n=234)。符合正态分布的计量资料2组间比较采用t检验;非正态分布计量资料2组间比较采用 Wilcoxon 秩和检验。计数资料2组间比较采用 χ2 检验,等级资料2组间比较采用 Wilcoxon 秩和检验。采用受试者工作特征曲线下面积(AUC)比较不同评分模型对90 d预后的预测价值。结果死亡组患者年龄(Z=-0.304,P=0.002)、TBil(Z=-5.961,P<0.001)、外周血WBC(Z=-6.027,P<0.001)、Cr(Z=-4.638,P<0.001)水平明显高于生存组,Hb(Z=-2.012,P=0.044)、Alb(Z=-4.007,P<0.001)、Na(Z=-4.558,P<0.001)水平明显低于生存组,死亡组并发症肝性脑病(Z=-7.859,P<0.001)、腹膜炎(Z=-2.310,P=0.021)、上消化道出血(χ2=11.697,P=0.001)发生率高于生存组,生存组凝血指标PT、INR、PTA优于死亡组(Z值分别为-7.737、-7.672、-7.867,P值均<0.001)。各评分模型MELD、MELD-Na、CLIF-C OFs、CLIF-C ACLFs、COSSH-ACLFs的AUC分别为0.726、0.587、0.712、0.735、0.750,COSSH-ACLFs模型的AUC均大于其他4个模型(Z值分别为7.89、18.83、12.49、5.05,P值均<0.001)。结论 COSSH-ACLFs评分模型对HBV-ACLF患者短期生存预后的预测价值优于 CLIF-C ACLFs、MELD、CLIF-C OFs、MELD-Na。
【Abstract】:Objective To investigate the value of the COSSH-ACLFs model in predicting the short-term (90-day) prognosis of patient with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods A total of 573 patients who were diagnosed with HBV-ACLF in The Affiliated Hospital of Southwest Medical University, The First People’s Hospital of Neijiang, and The Second People’s Hospital of Yibin were enrolled, and their general information and laboratory markers were collected. According to the outcome on day 90 after diagnosis, the patients were divided into survival group with 339 patients and death group with 234 patients. The t-test was used for comparison of normally distributed continuous data between two groups, and the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups, and the Wilcoxon rank sum test was used for comparison of ranked data between two groups. The area under the receiver operating characteristic curve (AUC) was used to compare the value of different models in predicting 90-day prognosis. Results Compared with the survival group, the death group had significantly higher age (Z=-0.304, P=0.002), bilirubin (Z=-5.961, P<0.001), peripheral white blood cell count (Z=-6.027, P<0.001), and creatinine (Z=-4.638, P<0.001), significantly lower hemoglobin (Z=-2.012, P=0.044), albumin (Z=-4.007, P<0.001), and Na (Z=-4.558, P<0.001), and significantly higher incidence rates of hepatic encephalopathy (Z=-7.859, P<0.001), peritonitis (Z=-2.310, P=0.021), and upper gastrointestinal bleeding (χ2=11.697, P=0.001). Compared with the death group, the survival group had significantly better coagulation markers, prothrombin time, international normalized ratio, and prothrombin time activity (Z=-7.737, -7.672, and -7.867, all P<0.001). MELD, MELD-Na, CLIF-COFs, CLIF-CACLFs, and COSSH-ACLFs had an area under the ROC curve (AUC) of 0.726, 0.587, 0.712, 0.735, and 0.750, respectively, and the COSSH-ACLFs model had a significantly larger AUC than the other four models (Z=7.89, 18.83, 12.49, and 5.05, all P<0.001).  Conclusion The COSSH-ACLFs model has a better value than CLIF-C ACLFs, MELD, CLIF-C OFs, and MELD-Na in predicting the short-term prognosis of patients with HBV-ACLF.
【关键字】:乙型肝炎; 肝功能衰竭; 预后
【Key words】:hepatitis B; liver failure; prognosis
【引证本文】:TIAN XL, WU SL, WANG B, et al. Value of the COSSH-ACLFs model in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure[J]. J Clin Hepatol, 2020, 36(6): 1258-1262. (in Chinese)
田小利, 吴松林, 王波, 等. COSSH-ACLFs评分模型对HBV相关慢加急性肝衰竭患者短期预后的预测价值[J]. 临床肝胆病杂志, 2020, 36(6): 1258-1262.

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