MELD评分、ALBI评分联合β2-微球蛋白对肝硬化合并急性肾损伤的预测价值
DOI: 10.3969/j.issn.1001-5256.2023.12.014
Value of Model for End-Stage Liver Disease score and albumin-bilirubin score combined with β2-microglobulin in predicting liver cirrhosis with acute kidney injury
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摘要:
目的 探讨终末期肝病模型(MELD)评分、白蛋白-胆红素(ALBI)评分和β2-微球蛋白联合检测对肝硬化合并急性肾损伤(AKI)的诊断价值。 方法 收集2019年10月—2022年10月在郑州大学第一附属医院就诊的258例肝硬化患者的临床资料,根据是否合并AKI分为AKI组(n=117)和非AKI组(n=141),比较AKI组和非AKI组以及不同肾损伤分期患者之间各指标变化。符合正态分布的计量资料两组间比较采用成组t检验,多组间比较采用单因素方差分析;不符合正态分布的计量资料两组间比较采用Mann-Whithey U检验,多组间比较采用Kruskal-Wallis H检验。计数资料两组间比较采用χ2检验。绘制受试者工作特征曲线(ROC曲线)评估各指标对肝硬化合并AKI的诊断效能。 结果 肝硬化合并AKI组在年龄(t=2.307,P=0.022)、合并肝性脑病(χ2=18.064,P<0.001)、合并自发性腹膜炎(χ2=16.397,P<0.001)、病死率(χ2=45.251,P<0.001)、肌酐(Z=-8.737,P<0.001)、β2-微球蛋白(Z=-8.829,P<0.001)、CTP评分(Z=-4.058,P<0.001)、ALBI评分(t=2.563,P=0.011)、MELD评分(Z=-5.628,P<0.001)上明显高于非AKI组,住院天数(Z=-3.391,P=0.001)少于非AKI组。AKI 1、2、3期患者肌酐、β2-微球蛋白、MELD评分、ALBI评分之间差异存在统计学意义(P值均<0.05),CTP评分在3组之间差异无统计学意义(P>0.05)。ALBI评分、MELD评分和β2-微球蛋白联合检测的AUC为0.837(95%CI:0.782~0.892),敏感度75.2%,特异度90.8%,ALBI评分和MELD评分联合诊断的AUC为0.700(95%CI:0.636~0.764),ALBI评分和β2-微球蛋白联合诊断的AUC为0.823(95%CI:0.765~0.881),MELD评分和β2-微球蛋白联合诊断的AUC为0.835(95%CI:0.779~0.890),ALBI评分、MELD评分和β2-微球蛋白联合检测对肝硬化合并AKI的诊断效能优于ALBI评分、MELD评分、β2-微球蛋白两两组合以及单一指标,同时也优于肌酐的诊断效能。 结论 ALBI评分、MELD评分和β2-微球蛋白联合检测对肝硬化合并AKI具有较高的诊断价值。 Abstract:Objective To investigate the value of combined determination of Model for End-Stage Liver Disease (MELD) score, albumin-bilirubin (ALBI) score, and β2-microglobulin in the diagnosis of liver cirrhosis with acute kidney injury (AKI). Methods Clinical data were collected from 258 patients with liver cirrhosis who attended The First Affiliated Hospital of Zhengzhou University from October 2019 to October 2022, and according to the presence or absence of AKI, they were divided into AKI group with 117 patients and non-AKI group with 141 patients. The changes in each index were compared between the two groups and between the patients with different stages of kidney injury. The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and a one-way analysis of variance was used for comparison between multiple groups; the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison between multiple groups; the chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic (ROC) curve was plotted to evaluate the efficacy of each index in the diagnosis of liver cirrhosis with AKI. Results Compared with the non-AKI group, the AKI group had significantly higher age (t=2.307, P=0.022), proportion of patients with hepatic encephalopathy (χ2=18.064, P<0.001) or with spontaneous peritonitis (χ2=16.397, P<0.001), mortality rate (χ2=45.251, P<0.001), levels of creatinine (Z=-8.737, P<0.001) and β2-microglobulin (Z=-8.829, P<0.001), and scores of CTP (Z=-4.058, P<0.001), ALBI (t=2.563, P=0.011), and MELD (Z=-5.628, P<0.001), as well as a significantly shorter length of hospital stay (Z=-3.391, P=0.001). There were significant differences in creatinine, β2-microglobulin, MELD score, and ALBI score between the patients with stage 1, 2 or 3 AKI (P<0.05), while there was no significant difference in CTP score between these three groups (P>0.05). The combined determination of ALBI score, MELD score, and β2-microglobulin had an area under the ROC curve (AUC) of 0.837 (95% confidence interval [CI]: 0.782 — 0.892), with a sensitivity of 75.2% and a specificity of 90.8%; ALBI score combined with MELD score had an AUC of 0.700 (95%CI: 0.636 — 0.764), ALBI score combined with β2 microglobulin had an AUC of 0.823 (95%CI: 0.765 — 0.881), and MELD combined with and β2 microglobulin had an AUC of 0.835 (95%CI: 0.779 — 0.890), suggesting that combined determination of ALBI score, MELD score, and β2-microglobulin had a better diagnostic efficacy than ALBI score, MELD score, or β2-microglobulin used alone or in pairs, as well as a better diagnostic efficacy than creatinine. Conclusion Combined determination of ALBI score, MELD score, and β2-microglobulin has a relatively high value in the diagnosis of liver cirrhosis with AKI. -
Key words:
- Liver Cirrhosis /
- Acute Kidney Injury /
- Organ Dysfunction Scores /
- beta 2-Microglobulin /
- Diagnosis
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表 1 两组患者基本临床资料的比较
Table 1. Comparison of basic clinical data of study subjects
项目 AKI组(n=117) 非AKI组(n=141) 统计值 P值 性别[例(%)] χ2=5.895 0.015 男 102(87.18) 106(75.18) 女 15(12.82) 35(24.82) 年龄(岁) 54±11 51±12 t=2.307 0.022 病因[例(%)] χ2=3.672 0.597 乙型肝炎 81(69.23) 98(69.50) 丙型肝炎 2(1.71) 6(4.26) 酒精性肝病 17(14.53) 18(12.77) 自身免疫性肝病 6(5.13) 11(7.80) 其他 11(9.40) 8(5.67) 合并症[例(%)] 肝性脑病 58(49.57) 34(24.11) χ2=18.064 <0.001 腹腔积液 108(92.31) 129(91.49) χ2=0.057 0.811 消化道出血 22(15.60) 21(14.89) χ2=0.704 0.402 自发性腹膜炎 43(25.14) 21(14.89) χ2=16.397 <0.001 其他部位感染 50(42.74) 61(43.26) χ2=0.007 0.932 住院时间(d) 17(9~30) 22(16~31) Z=-3.393 0.001 死亡人数[例(%)] 33(28.20) 1(0.71) χ2=45.251 <0.001 表 2 AKI组和非AKI组实验室指标及不同评分系统比较
Table 2. Comparison of laboratory indexes and different scoring systems between AKI group and non-AKI group
项目 AKI组(n=117) 非AKI组(n=141) 统计值 P值 肌酐(μmol/L) 106.0(69.2~158.5) 59.0(51.0~73.2) Z=-8.737 <0.001 β2-微球蛋白(mg/L) 5.80(4.085~7.73) 3.12(2.61~3.75) Z=-8.829 <0.001 CTP评分 12(10~13) 11(9~12) Z=-4.058 <0.001 ALBI评分 -1.08±0.52 -1.24±0.48 t=2.563 0.011 MELD评分 27.60(18.92~37.87) 18.05(11.48~28.89) Z=-5.628 <0.001 表 3 不同肾损伤分期患者实验室指标及不同评分系统比较
Table 3. Comparison of laboratory indexes and different scoring systems in patients with different stages of renal injury
项目 AKI 1期(n=63) AKI 2期(n=35) AKI 3期(n=19) 统计值 P值 肌酐(μmol/L) 100.1(66.0~121.0) 112.0(77.0~166.0) 200.0(65.0~358.0) H=10.604 0.005 β2-微球蛋白(mg/L) 5.25(3.53~6.53) 6.22(4.20~8.42) 8.57(6.59~12.46) H=13.731 0.001 CTP评分 12(10~13) 11(10~13) 13(12~14) H=4.471 0.107 ALBI评分 -1.05±0.52 -1.26±0.54 -0.88±0.43 F=3.745 0.027 MELD评分 26.33±13.04 29.37±11.75 37.51±12.25 F=5.810 0.004 表 4 各指标诊断效能比较
Table 4. Diagnostic efficiency of each index
项目 截断值 AUC 敏感度(%) 特异度(%) 95%CI 肌酐 86.5 0.815 65.0 90.8 0.760~0.871 β2-微球蛋白 4.28 0.819 74.4 90.8 0.761~0.878 MELD评分 22.991 0.704 70.1 66.0 0.640~0.767 ALBI评分 -0.742 0.582 32.5 87.9 0.511~0.653 ALBI、MELD联合诊断 0.426 0.700 70.1 63.1 0.636~0.764 ALBI、β2-微球蛋白联合诊断 0.460 0.823 74.4 90.8 0.765~0.881 MELD、β2-微球蛋白联合诊断 0.447 0.835 75.2 90.8 0.779~0.890 ALBI、MELD、β2-微球蛋白联合诊断 0.452 0.837 75.2 90.8 0.782~0.892 -
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