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妊娠期特有性肝病的预后新模型分析
A new prognostic model for pregnancy-specific liver disease
文章发布日期:2018年09月30日  来源:  作者:吕苏聪  点击次数:267次  下载次数:43次

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【摘要】:目的探讨妊娠期特有性肝病(PSLD)患者的预后因素,使用统计学方法构建简便有效的预后模型(NEW模型),分析终末期肝病模型(MELD模型)与NEW模型对PSLD患者的预后评估价值。方法选取广州医科大学附属第三医院2015年1月1日-2017年12月31日以黄疸和肝功能不全入院,且诊断为妊娠期急性脂肪肝、子痫前期或HELLP综合征的妊娠期患者共84例。根据预后情况,将上述病例分为死亡组(n=14)和生存组(n=70),分别以MELD模型、NEW模型对患者进行评分,计算各模型的敏感度、特异度、阳性预测值和阴性预测值,最后以受试者工作特征曲线(ROC曲线)衡量2种模型评估PSLD预后的能力。计量资料2组间比较采用t检验,计数资料2组间比较采用χ2检验;运用logistic回归分析PSLD预后模型。结果生存组与死亡组比较,TBil、DBil、血清肌酐、INR、ALP、血清总蛋白、Alb等指标差异均有统计学意义(t值分别为-6.33、-5.38、-3.38、-11.56、-4.63、3.00、219,P值均<005)。选择INR,以此建立NEW模型(R=5812×INR-113)。MELD模型和NEW模型均表达出良好的预测价值,ROC曲线下面积分别为0.952(95%可信区间: 0.906~0.997,P<0.05)、0.982(95%可信区间: 0.958~1.000,P<0.05);敏感度分别为92.9%、100.0%;特异度分别为87.3%、94.4%。随着分值升高,患者病死率亦呈上升趋势,MELD<25分,病死率为0,MELD>40分,病死率达818%;当R<-3分,病死率为0,R>0分时,病死率达84.6%。结论MELD模型和NEW模型均能在不同程度上反应PSLD患者的预后,且NEW模型在仅参考INR的基础上即得到良好的评估预后的效果,具有良好的临床指导价值。
【Abstract】:ObjectiveTo investigate the prognostic factors for pregnancy-specific liver disease (PSLD), to establish a simple effective model (NEW mode) using the statistic method, and to investigate the value of Model for End-Stage Liver Disease (MELD) and NEW model in the prognostic evaluation of PSLD patients. MethodsA total of 84 pregnant patients who were admitted to The Third Affiliated Hospital of Guangzhou Medical University due to jaundice and hepatic insufficiency from January 1, 2015 to December 31, 2017 and were diagnosed with acute fatty liver of pregnancy, preeclampsia, or hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome were enrolled. According to their prognosis, they were divided into death group with 14 patients and survival group with 70 patients. The MELD model and the NEW model were used for scoring, the sensitivity, specificity, positive predictive value, and negative predictive value of the two models were calculated, and the receiver operating characteristic (ROC) curve was used to assess the value of these two models in predicting the prognosis of PSLD. The t-test was used for comparison of continuous data between two groups, the chi-square test was used for comparison of categorical data between two groups, and the logistic regression model was used to analyze the prognostic models of PSLD. ResultsThe univariate analysis showed that there were significant differences between the two groups in total bilirubin, direct bilirubin, serum creatinine, international normalized ratio (INR), alkaline phosphatase, serum total protein, and albumin (t=-6.33, -5.38, -338, -11.56, -4.63, 3.00, and 2.19, all P<0.05), among which INR showed the most significant difference and was thus used to establish the NEW model(R=5812×INR-113). Both MELD model and NEW model demonstrated a good predictive value, with an area under the ROC curve of 0.952 (95% confidence interval [CI]: 0.906-0.997, P<0.05) and 0.982 (95%CI: 0.958-1.000, P<0.05), respectively, a sensitivity of 92.9% and 100%, respectively, and a specificity of 87.3% and 94.4%, respectively. Higher scores of MELD model and NEW model were associated with higher fatality rates; the fatality rate was 0 when MELD score was lower than 25, but it increased to 81.8% when MELD score was above 40; the fatality rate was 0 when R score was lower than -3, but it increased to 84.6% when R score was above 0. ConclusionBoth MELD model and NEW model can predict the prognosis of PSLD patients. The NEW model with reference to INR alone achieves a good value in evaluating prognosis and thus has a good clinical value.
【关键字】:肝疾病; 妊娠并发症; 预后; MELD模型; NEW模型
【Key words】:liver disease; pregnancy complications; prognosis; MELD mode; NEW mode
【引证本文】:LYU SC. A new prognostic model for pregnancy-specific liver disease[J]. J Clin Hepatol, 2018, 34(11): 2388-2391. (in Chinese) 吕苏聪. 妊娠期特有性肝病的预后新模型分析[J]. 临床肝胆病杂志, 2018, 34(11): 2388-2391.

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