终末期肝病模型及CTP评分系统对土三七相关肝窦阻塞综合征患者预后的预测价值

刘贞利; 范作鹏; 柳雅立; 张晶

doi:10.3969/j.issn.1001-5256.2020.11.013

终末期肝病模型及CTP评分系统对土三七相关肝窦阻塞综合征患者预后的预测价值

DOI: 10.3969/j.issn.1001-5256.2020.11.013

首都医科大学附属北京佑安医院肝病中心三科

基金项目:

2018年度院内中青年人才孵育项目（YNKTTS20180115）；

详细信息

中图分类号: R575
计量
- 文章访问数: 4395
- HTML全文浏览量: 19
- PDF下载量: 85
- 被引次数: 0
出版历程
- 收稿日期: 2020-04-26
- 出版日期: 2020-11-20

Value of Model for End-Stage Liver Disease and Child-Turcotte-Pugh score in predicting the prognosis of patients with hepatic sinus obstruction syndrome associated with Gynura segetum( Lour. ) Merr.

Third Department of Department of Hepatology,Beijing YouAn Hospital,Capital Medical University

Research funding:

摘要

摘要:
目的研究应用终末期肝病模型（MELD评分）和Child-Tureotte-Pugh评分（CTP评分）系统预测肝窦阻塞综合征患者预后的临床价值。方法选取2012年1月-2018年7月北京佑安医院、北京地坛医院、解放军总医院第五医学中心、天津市第三中心医院、新乡医学院第一附属医院5家医院收治的土三七相关肝窦阻塞综合征患者49例,随访3年,终点事件为死亡。根据患者入院时的实验室检查及临床资料,计算患者MELD和CTP评分,根据CTP评分将患者分为3组:CTP A级组（评分5～6分）（n=8）、CTP B级组（评分7～9分）（n=23）及CTP C级组（评分≥10分）（n=18）;根据随访期间患者临床结局分为死亡组（n=12）和生存组（n=37）。计量资料组间比较采用Mann-Whitney U检验,等级资料采用Kruskal-Wallis H检验。受试者工作特征曲线下面积（AUC）用于判定CTP、MELD评分对死亡的预测能力。Kaplane-Meier生存曲线用于判定不同CTP、MELD评分患者的长期预后情况,采用log-rank进行比较。应用受试者工作特征曲线分析两种评分系统对患者死亡的预...
- 肝静脉闭塞性疾病 /
- 终末期肝病模型 /
- Child-Pugh评分
Abstract:
Objective To investigate the value of Model for End-Stage Liver Disease( MELD) and Child-Turcotte-Pugh( CTP) score in predicting the prognosis of patients with hepatic sinusoidal obstruction syndrome( HSOS) associated with Gynura segetum( Lour.) Merr.Methods A total of 49 patients with HSOS associated with Gynura segetum( Lour.) Merr. who were admitted to Beijing YouAn Hospital,Beijing Ditan Hospital,The Fifth Medical Center of Chinese PLA General Hospital,Tianjin Third Central Hospital,and The First Affiliated Hospital of Xinxiang Medical University from January 2012 to July 2018 were enrolled and followed up for three years,with death as the outcome event. MELD and CTP scores were calculated according to the laboratory examination and clinical data on admission,and according to CTP score,the patients were divided into CTP class A( CTP score 5-6) group( n = 8),CTP class B( CTP score 7-9) group( n = 23),and CTP class C( CTP score ≥10) group( n = 18). The patients were divided into death group( n = 12) and survival group( n = 37) according to the clinical outcome during follow-up. The Mann-Whitney U test was used for comparison of continuous data between groups,and the Kruskal-Wallis H test was used for ranked data. The area under the receiver operator characteristic( ROC) curve( AUC) was used to investigate the ability of CTP and MELD scores in predicting death. The Kaplan-Meier survival curves were used to determine the long-term prognosis of patients with different CTP and MELD scores,and the log-rank test was used for comparison. The ROC curve was used to evaluate the performance of these two scoring systems in predicting death. Results A total of 12 patients died during the 3-year follow-up period. The patients with HSOS had a median MELD score of 13. 443( 8. 792-18. 379),and the death group had a significantly higher MELD score than the survival group [19. 84( 15. 49-25. 41) vs 11. 58( 8. 60-15. 79),Z =-3. 511,P < 0. 001]. The patients with HSOS had a CTP score of 6-12,and of all 49 patients,8( 16. 3%) had CTP class A HSOS,23( 46. 9%) had CTP class B HSOS,and18( 36. 7%) had CTP class C HSOS. The mortality rate of the patients increased significantly with the increase in CTP score( χ2= 16. 078,P < 0. 05). The mortality rates of the patients with CTP class A,B,and C HSOS were 0. 0%,13. 0%,and 50. 0%,respectively( χ2=10. 343,P < 0. 05). The Kaplan-Meier analysis showed that the patients with a MELD score of < 14. 294 4 had a significantly better 3-year prognosis than those with a MELD score of ≥14. 294 4( χ2= 14. 893,P < 0. 001). The higher the CTP score,the poorer the 3-year prognosis of patients( χ2= 11. 083,P < 0. 05). CTP class had an AUC of 0. 780( 95% confidence interval [CI]: 0. 639-0. 922) in predicting the prognosis of HSOS patients,while MELD score had an AUC of 0. 840( 95% CI: 0. 722-0. 958),and there was no significant difference between the two scores( Z = 2. 63,P > 0. 05). Conclusion Both MELD and CTP scores can predict the risk of death in patients with HSOS,with similar performance in predicting the prognosis of patients,and further studies are needed to validate their clinical value.
- hepatic veno-occlusive disease /
- model for end stage liver disease /
- Child-Tureotte-Pugh

HTML全文

参考文献(20)

[1] Cooperative Group for Hepatic and Gall Diseases,Chinese Society of Gastroenterology,Chinese Medical Association. Expert consensus on diagnosis and treatment of quinazoline alkaloidsrelated sinusoidal obstruction syndrome(2017,Nanjing)[J]. J Clin Hepatol,2017,33(9):1627-1637.(in Chinese)中华医学会消化病学分会肝胆疾病协作组．吡咯生物碱相关肝窦阻塞综合征诊断和治疗专家共识意见(2017年，南京)[J]．临床肝胆病杂志，2017,33(9):1627-1637.

[2] WANG JY,GAO H. Tusanqi and hepatic sinusoidal obstruction syndrome[J]. J Dig Dis,2014,15(3):105-107.

[3] GAO H,LI N,WANG JY,et al. Definitive diagnosis of hepatic sinusoidal obstruction syndrome induced by pyrrolizidine alkaloids[J]. J Dig Dis,2012,13(1):33-39.

[4] ZHUGE YZ,LIU Y,XIE W,et al. Expert consensus on the clinical management of pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome[J]. J Gastroenterol Hepatol,2019,34(4):634-642.

[5] LIU F,RONG XX,GUO H,et al. Clinical characteristics,CT signs,and pathological findings of Pyrrolizidine alkaloids-induced sinusoidal obstructive syndrome:A retrospective study[J]. BMC Gastroenterol,2020,20(1):30.

[6] WANG Y,QIAO D,LI Y,et al. Risk factors for hepatic venoocclusive disease caused by Gynura segetum:A retrospective study[J]. BMC Gastroenterol,2018,18(1):156.

[7] REN XF,ZHUGE YZ,CHEN SY,et al. Gynura segetum-related hepatic sinusoidal obstruction syndrome:A national multicenter clinical study[J]. Chin J Dig,2017,37(8):523-529.(in Chinese)任晓非，诸葛宇征，陈世耀，等．土三七相关肝窦阻塞综合征的全国多中心临床调研分析[J]．中华消化杂志，2017,37(8):523-529.

[8] HOFFMANN K,HINZ U,HILLEBRAND N,et al. The meld score predicts the short-term and overall survival after liver transplanta tion in patients with primary sclerosing cholangitis or autoim mune liver diseases[J]. Langenbecks Arch Surg,2014,399(8):1001-1009.

[9] PUGH RN,MURRAY-LYON IM,DAWSON JL,et al. Transection of the oesophagus for bleeding oesophageal varices[J]. Br J Surg,1973,60(8):646-649.

[10] PENG Y,QI X,GUO X. Child-Pugh versus MELD score for the assessment of prognosis in liver cirrhosis:A systematic review and meta-analysis of observational studies[J]. Medicine,2016,95(8):e2877.

[11] SINGAL AK,KAMATH PS. Model for end-stage liver disease[J]. J Clin Exp Hepatol,2013,3(1):50-60.

[12] European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites,spontaneous bacterial peritonitis,and hepatorenal syndrome in cirrhosis[J]. J Hepatol,2010,53(3):397-417.

[13] Chinese Society of Gastroenterology and Chinese Society of Hepatology,Chinese Medical Association. Consensus on the diagnosis and treatment of hepatic encephalopathy in China(Chongqing,2013)[J/CD]. Chin J Front Med Sci(Electronic Version),2014,(2):81-93.(in Chinese)中华医学会消化病学分会，中华医学会肝病学分会．中国肝性脑病诊治共识意见(2013年，重庆)[J/CD]．中国医学前沿杂志(电子版)，2014,(2):81-93.

[14] LIU ZL,FAN ZP,GOU YS,et al. Clinical features,pathogenesis,and diagnosis and treatment of different types of hepatic sinusoidal obstruction syndrome[J]. J Clin Hepatol,2019,35(1):208-212.(in Chinese)刘贞利，范作鹏，勾钰淞，等．不同类型肝窦阻塞综合征的临床特征、发病机制与诊治[J]．临床肝胆病杂志，2019,35(1):208-212.

[15] ZHANG Y,JIANG HY,WEI Y,et al. Sinusoidal obstruction syndrome:A systematic review of etiologies,clinical symptoms,and magnetic resonance imaging features[J]. World J Clin Cases,2019,7(18):2746-2759.

[16] PENG CY,ZHANG XF,ZHANG F,et al. Clinical efficacy and safety of anticoagulation therapy for Pyrrolizidine alkaloids-induced hepatic sinusoidal obstruction syndrome:A retrospective multicenter cohort study[J]. Eur J Gastroenterol Hepatol,2020,32(9):1168-1178.

[17] WEI LY,ZHAI YZ,FENG GH. Clinical study of serum prealbumin combined with Child-Pugh classification and MELD score for evaluation of liver function in patients with liver cirrhosis[J].World Chin J Dig,2014,22(13):1871-1875.(in Chinese)韦丽娅，翟永贞，冯国和．血清前白蛋白结合Child-Pugh分级及MELD评分对肝硬化肝脏功能的评价[J]．世界华人消化杂志，2014,22(13):1871-1875.

[18] MC PHAIL MJ,FARNE H,SENVAR N,et al. Ability of king’s college criteria and model for end-stage liver disease scores to predict mortality of patients with acute liver failure:A metaanalysis[J]. Clin Gastroenterol Hepatol,2016,14(4):516-525.

[19] CHO HC,HAN YJ,DONG HS,et al. Mortality after surgery in patients with liver cirrhosis:Comparison of Child-TurcottePugh,MELD and MELD-Na score[J]. Eur J Gastroenterol Hepatol,2011,23(1):51-57.

[20] SRIKUREJA W,KYULO NL,RUNYON BA,et al. MELD score is a better prognostic model than Child-Turcotte-Pugh score or discriminant function score in patients with alcoholic hepatitis[J]. J Hepatol,2005,124(5):700-708.

施引文献

资源附件(0)

访问统计