MELD-Na、CLIF-SOFA、AARC-ACLF對(duì)乙型肝炎相關(guān)慢加急性肝衰竭短期預(yù)后的診斷價(jià)值
發(fā)布時(shí)間：2018-10-07 18:47
【摘要】：目的由乙型肝炎病毒引起的慢加急性肝衰竭(hepatitis B virus related acute-on-chronic liver failure,HBV-ACLF),預(yù)后極差,短期病死率極高,患者對(duì)治療效果反應(yīng)差,住院周期相對(duì)較長(zhǎng),該病是目前我國(guó)最常見(jiàn)的因肝臟疾病而死亡的原因,且近年發(fā)病率有增加趨勢(shì)[1]。但此病不是肝病的終末期,如果能夠及時(shí)干預(yù),病情有可能好轉(zhuǎn)[2]。國(guó)內(nèi)外專家進(jìn)行了大量研究,從單因素分析到多因素分析,相繼建立了多種評(píng)估肝病預(yù)后的模型,但目前并沒(méi)有評(píng)價(jià)HBV-ACLF預(yù)后的特異性評(píng)分或模型。各模型在臨床上的運(yùn)用及受到的評(píng)價(jià)褒貶不一。本研究選取了已得到頻繁應(yīng)用、在歐美人群數(shù)據(jù)建立起的兩個(gè)模型,終末期肝病模型聯(lián)合血清鈉(MELD-Na)及慢性肝衰竭-序貫器官衰竭評(píng)估(CLIF-SOFA)評(píng)分,以及近年新建立的針對(duì)亞洲ACLF人群研究的亞太肝臟研究協(xié)會(huì)慢加急性肝衰竭研究小組(AARC-ACLF)評(píng)分。由于東西方肝病患者肝臟損傷病因不同,ACLF診斷標(biāo)準(zhǔn)、預(yù)后判斷等均有明顯差異[3-4]。我國(guó)ACLF的定義與APASL專家共識(shí)基本一致,但AARC-ACLF目前尚未在我國(guó)臨床工作中廣泛應(yīng)用,上述評(píng)分系統(tǒng)是否適于我國(guó)HBV-ACLF患者需要進(jìn)一步討論研究。本研究將進(jìn)一步探索比較MELD-Na、CLIF-SOFA、AARC-ACLF對(duì)預(yù)測(cè)HBV-ACLF患者短期預(yù)后的診斷價(jià)值。方法選取72例HBV-ACLF患者,根據(jù)從診斷ACLF至診斷后3個(gè)月時(shí)的預(yù)后分為2組,經(jīng)內(nèi)科治療病情穩(wěn)定或好轉(zhuǎn)為A組(29例),治療無(wú)效行肝移植或死亡者歸為B組(43例)。收集患者入院后確診ACLF時(shí)的臨床資料,選取患者同期臨床指標(biāo),比較2組的年齡(Age)、凝血酶原時(shí)間(PT)、國(guó)際標(biāo)準(zhǔn)化比值(INR)、凝血酶原活動(dòng)度(PTA)、總膽紅素(TBIL)、甲胎蛋白(AFP)、血氨(NH3)、血清肌酐(Cr)、動(dòng)脈血中的酸堿度(PH)、白蛋白(ALB)、血清鈉(Na)、靜脈血乳酸(LAC)、膽堿酯酶(CHE)、平均動(dòng)脈壓(MAP)、MELD-Na、CLIF-SOFA、AARC-ACLF分值等,使用受試者工作特征(ROC)曲線下面積(AUC)評(píng)價(jià)上述評(píng)分系統(tǒng)對(duì)ACLF短期預(yù)后診斷的預(yù)測(cè)價(jià)值。結(jié)果B組的PT、TBIL、INR、PTA、MELD-Na、AARC-ACLF、CLIF-SOFA高于A組,Na低于A組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組的Age、Cr、ALB、CHE、AFP、NH3、PH、LAC、MAP,無(wú)明顯統(tǒng)計(jì)學(xué)差異。3種評(píng)分系統(tǒng)的AUC均大于0.7,提示診斷價(jià)值中等。CLIF-SOFA評(píng)分曲線下面積(AUC 0.887)優(yōu)于MELD-Na評(píng)分的曲線下面積(AUC 0.764),差異有統(tǒng)計(jì)學(xué)意義(Z 2.255,P0.0167),CLIF-SOFA和AARC-ACLF評(píng)分的曲線下面積(AUC分別為0.887、0.825)、MELD-Na和AARC-ACLF評(píng)分的曲線下面積(AUC分別為0.764、0.825)差異均無(wú)統(tǒng)計(jì)學(xué)意義(Z分別為1.361、1.127,P0.0167),MELD-Na、CLIF-SOFA、AARC-ACLF評(píng)分所得最佳臨界值分別為23.84、8.50、8.50。結(jié)論3種評(píng)分系統(tǒng)均能較好地預(yù)測(cè)乙型肝炎相關(guān)慢加急性肝衰竭患者的短期臨床預(yù)后,AARC-ACLF評(píng)分系統(tǒng)的研究基礎(chǔ)是亞洲人群,所需相關(guān)指標(biāo)方便獲得,計(jì)算過(guò)程簡(jiǎn)單,臨床應(yīng)用價(jià)值更高。
[Abstract]:Objective (hepatitis B virus related acute-on-chronic liver failure,HBV-ACLF caused by hepatitis B virus has poor prognosis, high short-term mortality, poor response to treatment, and relatively long hospitalization period. The disease is the most common cause of death due to liver disease in China, and the incidence of the disease is increasing in recent years. But this disease is not the end stage of liver disease, if can intervene in time, the condition is likely to improve [2]. Domestic and foreign experts have done a lot of research, from univariate analysis to multivariate analysis, have established a variety of models to assess the prognosis of liver disease, but there is no specific score or model to evaluate the prognosis of HBV-ACLF. The clinical application and evaluation of the models are mixed. In this study, we selected two models, which have been used frequently and have been established in European and American population data, the end-stage liver disease model combined with serum sodium (MELD-Na) and chronic hepatic failure-sequential organ failure (CLIF-SOFA) score. And the newly established Asia Pacific liver Research Association (AHA) slow plus Acute Hepatic failure (AARC-ACLF) score for Asian ACLF population study in recent years. There were significant differences in the diagnosis criteria and prognosis of ACLF due to the difference of the etiology of liver injury between the East and the West patients with liver disease [3-4]. The definition of ACLF in China is basically consistent with that of APASL experts, but AARC-ACLF has not been widely used in clinical work in China at present. Whether the above scoring system is suitable for HBV-ACLF patients in our country needs further discussion and study. This study will further explore the diagnostic value of MELD-Na,CLIF-SOFA,AARC-ACLF in predicting short-term prognosis in patients with HBV-ACLF. Methods Seventy-two patients with HBV-ACLF were divided into two groups according to the prognosis from diagnosis of ACLF to 3 months after diagnosis. After medical treatment, the patients were stable or improved to group A (29 cases), and the patients with ineffective liver transplantation or death were classified into group B (43 cases). To collect the clinical data of the patients with ACLF after admission, and select the clinical indexes of the same period. Comparison of age (Age), prothrombin time (PT), international standardized ratio (INR), prothrombin activity (PTA), total bilirubin (TBIL), alpha-fetoprotein (AFP), blood ammonia (NH3) serum creatinine (Cr), arterial blood pH (PH), (ALB), albumin serum sodium (Na), venous milk The mean arterial pressure (MAP) of (LAC), cholinesterase (CHE),) and the score of CLIF-SOFAA AARC-ACLF, etc. The area (AUC) under the operating characteristic (ROC) curve was used to evaluate the predictive value of the above scoring system in the diagnosis of short-term prognosis of ACLF. Results the PT,TBIL,INR,PTA,MELD-Na,AARC-ACLF,CLIF-SOFA of group B was higher than that of group A (P 0.05). There was no significant difference in Age,Cr,ALB,CHE,AFP,NH3,PH,LAC,MAP, between the two groups. The AUC of all kinds of scoring system was greater than 0.7, suggesting that the area under the curve of CLIF-sofa score (AUC 0.887) was better than the area under curve of MELD-Na score (AUC 0.764), and the difference was statistically significant (Z 2.255 P 0.0167). There was no significant difference in the area under the curve (AUC = 0.887 / 0.825) and the area under the curve (AUC = 0.764 鹵0.825) in MELD-Na and AARC-ACLF scores (Z = 1.361 / 1.127, P 0.0167, respectively). The best critical value obtained from MELD-NaOH CLIF-SOFAA AARC-ACLF score was 23.848.50 and 8.50 respectively. Conclusion the AARC-ACLF scoring system for predicting the short-term prognosis of patients with chronic hepatitis B associated with acute liver failure is based on the Asian population. The clinical application value is higher.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R512.62;R575.3
本文編號(hào)：2255286
[Abstract]:Objective (hepatitis B virus related acute-on-chronic liver failure,HBV-ACLF caused by hepatitis B virus has poor prognosis, high short-term mortality, poor response to treatment, and relatively long hospitalization period. The disease is the most common cause of death due to liver disease in China, and the incidence of the disease is increasing in recent years. But this disease is not the end stage of liver disease, if can intervene in time, the condition is likely to improve [2]. Domestic and foreign experts have done a lot of research, from univariate analysis to multivariate analysis, have established a variety of models to assess the prognosis of liver disease, but there is no specific score or model to evaluate the prognosis of HBV-ACLF. The clinical application and evaluation of the models are mixed. In this study, we selected two models, which have been used frequently and have been established in European and American population data, the end-stage liver disease model combined with serum sodium (MELD-Na) and chronic hepatic failure-sequential organ failure (CLIF-SOFA) score. And the newly established Asia Pacific liver Research Association (AHA) slow plus Acute Hepatic failure (AARC-ACLF) score for Asian ACLF population study in recent years. There were significant differences in the diagnosis criteria and prognosis of ACLF due to the difference of the etiology of liver injury between the East and the West patients with liver disease [3-4]. The definition of ACLF in China is basically consistent with that of APASL experts, but AARC-ACLF has not been widely used in clinical work in China at present. Whether the above scoring system is suitable for HBV-ACLF patients in our country needs further discussion and study. This study will further explore the diagnostic value of MELD-Na,CLIF-SOFA,AARC-ACLF in predicting short-term prognosis in patients with HBV-ACLF. Methods Seventy-two patients with HBV-ACLF were divided into two groups according to the prognosis from diagnosis of ACLF to 3 months after diagnosis. After medical treatment, the patients were stable or improved to group A (29 cases), and the patients with ineffective liver transplantation or death were classified into group B (43 cases). To collect the clinical data of the patients with ACLF after admission, and select the clinical indexes of the same period. Comparison of age (Age), prothrombin time (PT), international standardized ratio (INR), prothrombin activity (PTA), total bilirubin (TBIL), alpha-fetoprotein (AFP), blood ammonia (NH3) serum creatinine (Cr), arterial blood pH (PH), (ALB), albumin serum sodium (Na), venous milk The mean arterial pressure (MAP) of (LAC), cholinesterase (CHE),) and the score of CLIF-SOFAA AARC-ACLF, etc. The area (AUC) under the operating characteristic (ROC) curve was used to evaluate the predictive value of the above scoring system in the diagnosis of short-term prognosis of ACLF. Results the PT,TBIL,INR,PTA,MELD-Na,AARC-ACLF,CLIF-SOFA of group B was higher than that of group A (P 0.05). There was no significant difference in Age,Cr,ALB,CHE,AFP,NH3,PH,LAC,MAP, between the two groups. The AUC of all kinds of scoring system was greater than 0.7, suggesting that the area under the curve of CLIF-sofa score (AUC 0.887) was better than the area under curve of MELD-Na score (AUC 0.764), and the difference was statistically significant (Z 2.255 P 0.0167). There was no significant difference in the area under the curve (AUC = 0.887 / 0.825) and the area under the curve (AUC = 0.764 鹵0.825) in MELD-Na and AARC-ACLF scores (Z = 1.361 / 1.127, P 0.0167, respectively). The best critical value obtained from MELD-NaOH CLIF-SOFAA AARC-ACLF score was 23.848.50 and 8.50 respectively. Conclusion the AARC-ACLF scoring system for predicting the short-term prognosis of patients with chronic hepatitis B associated with acute liver failure is based on the Asian population. The clinical application value is higher.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R512.62;R575.3
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