不同指南诊断标准对人工肝治疗慢加急性肝衰竭患者短期预后的影响

陈宇航; 姜梓萌; 张志娇; 郑梦瑶; 王梅莲; 黄华; 赵公芳

doi:10.3969/j.issn.1001-5256.2023.11.017

不同指南诊断标准对人工肝治疗慢加急性肝衰竭患者短期预后的影响

DOI: 10.3969/j.issn.1001-5256.2023.11.017

昆明医科大学第二附属医院消化内科，昆明 650000

基金项目:

云南省“万人计划”名医人才专项 (YNWR-MY-2019-074)

伦理学声明：本研究方案于2022年4月8日经由昆明医科大学第二附属医院伦理委员会审批，批号：审-PJ-科-2022-109，患者均签署知情同意书。

利益冲突声明：本研究不存在任何利益冲突。

作者贡献声明：陈宇航负责文章的构思设计、论文撰写与修订；姜梓萌、张志娇负责数据的获取及分析处理过程；郑梦瑶、王梅莲对研究的思路有贡献；黄华、赵公芳参与修改文章的关键内容。

详细信息

通信作者:
赵公芳， zhaogongfangedu@163.com （ORCID： 0000-0001-9178-1567）

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出版历程
- 收稿日期: 2023-03-04
- 录用日期: 2023-04-14
- 出版日期: 2023-11-28

The influence of diagnostic criteria of different guidelines on short-term prognosis of artificial liver therapy for acute-on-chronic liver failure

Department of Gastroenterology，The Second Affiliated Hospital of Kunming Medical University，Kunming 650000，China

Research funding:

The Yunnan Province “Million People Program” of Famous Doctors and Talents Project (YNWR-MY-2019-074)

More Information

Corresponding author: ZHAO Gongfang， zhaogongfangedu@163.com （ORCID： 0000-0001-9178-1567）

摘要

摘要: 目的探讨不同诊断标准对慢加急性肝衰竭患者短期预后的影响。方法纳入2018年1月—2022年1月昆明医科大学第二附属医院消化内科住院的115例慢加急性肝衰竭患者，均采用内科联合人工肝治疗。根据指南将患者分为CMA指南组（中华医学会肝衰竭诊治指南）（n=100）、APASL指南组（亚太肝病学会共识）（n=94）和EASL指南组（欧洲肝病学会标准）（n=36），随访末次人工肝治疗后90 d生存情况。计量资料组间比较采用单因素方差分析，计数资料组间比较采用χ²检验。采用受试者工作特征曲线（ROC曲线）比较上述3个指南90 d病死率的差异以及对死亡风险的预测价值。结果 CMA指南组90 d病死率为50.0%，APASL指南组51.1%，EASL指南组77.8%，EASL指南组90 d病死率显著高于CMA指南组（χ²=8.351，P=0.004）和APASL指南组（χ²=7.650，P=0.006）；EASL指南对短期死亡风险预测的敏感度为22.2%，特异度为92.3%，对应的曲线下面积为0.576。结论符合EASL指南的慢加急性肝衰竭患者短期预后更差，该指南有助于识别短期死亡风险较高的患者。
- 慢加急性肝功能衰竭 /
- 肝，人工 /
- 预后
Abstract: Objective To investigate the influence of different diagnostic criteria on the short-term prognosis of patients with acute-on-chronic liver failure （ACLF）. Methods A total of 115 ACLF patients who were hospitalized in Department of Gastroenterology， The Second Affiliated Hospital of Kunming Medical University， from January 2018 to January 2022 were enrolled， and all patients received internal medical treatment combined with artificial liver therapy. According to the guidelines， the patients were divided into CMA guideline group （Diagnostic and treatment guidelines for liver failure by Chinese Medical Association）（n=100）， APASL guideline group （Consensus statements of Asian Pacific Association for the Study of the Liver）（n=94）， and EASL guideline group （Criteria proposed by European Association for the Study of the Liver）（n=36）. The above three guidelines were compared in terms of 90-day mortality rate. A one-way analysis of variance was used for comprision of continuous date between groups； the chi-square test was used for comprision of categorical date between groups. The receiver operating characteristic （ROC） curve of related variables. Results The 90-day mortality rate was 50.0% in the CMA guideline group， 51.1% in the APASL guideline group， and 77.8% in the EASL guideline group， and the EASL guideline group had a significantly higher 90-day mortality rate than the CMA guideline group （χ²=8.351， P=0.004） and the APASL guideline group （χ²=7.650， P=0.006）. EASL guideline had a sensitivity of 22.2% and a specificity of 92.3% in predicting the risk of short-term mortality， with an area under the ROC curve was 0.576. Conclusion ACLF patients who meet EASL guideline tend to have a worse short-term prognosis， and this guideline may help to identify patients at a relatively high risk of short-term death.
- Acute-On-Chronic Liver Failure /
- Liver， Artificial /
- Prognosis

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图 1 短期死亡风险的ROC曲线图

Figure 1. ROC curve of short-term death risk

下载: 全尺寸图片幻灯片

表 1 一般资料比较

Table 1. Comparison of general data

项目	CMA指南组（n=100）	APASL指南组（n=94）	EASL指南组（n=36）	统计值	P值
性别［例（%）］				χ²=0.017	0.992
男	70（70.0）	65（69.1）	25（69.4）
女	30（30.0）	29（30.9）	11（30.6）
年龄（岁）	49.9±12.3	49.5±11.8	53.5±12.2	F=1.543	0.216
病因［例（%）］				χ²=5.762	0.674
乙型肝炎	49（49.0）	46（48.9）	12（33.3）
丙型肝炎	2（2.0）	2（2.1）	1（2.8）
酒精性肝病	24（24.0）	23（24.5）	9（25.0）
自身免疫性肝病	11（11.0）	11（11.7）	4（11.1）
其他	14（14.0）	12（12.8）	10（27.8）
人工肝模式［例（%）］				χ²=4.201	0.379
PE	27（27.0）	30（31.9）	16（44.4）
DPMAS	55（55.0）	45（47.9）	15（41.7）
PE+DPMAS	18（18.0）	19（20.2）	5（13.9）
人工肝次数（次）	3.3±1.7	3.3±1.6	2.7±1.2	F=2.137	0.120
住院时长（d）	19.4±8.2	19.6±8.0	16.2±7.0	F=2.663	0.072
90 d病死率［例（%）］	50（50.0）^1）	48（51.1）^1）	28（77.8）	χ²=9.133	0.010
注：与EASL指南组比较，1） P<0.05。

下载: 导出CSV

表 2 3组赋值和人数统计

Table 2. Assignment and population statistics of the three groups

生存情况	赋值
生存情况	1=CMA指南组	2=APASL指南组	3=EASL指南组
死亡（例）	50	48	28
存活（例）	50	46	8
合计（例）	100	94	36

下载: 导出CSV

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