MELD-Na、CLIF-SOFA、AARC-ACLF對乙型肝炎相關慢加急性肝衰竭短期預后的診斷價值
發(fā)布時間：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),預后極差,短期病死率極高,患者對治療效果反應差,住院周期相對較長,該病是目前我國最常見的因肝臟疾病而死亡的原因,且近年發(fā)病率有增加趨勢[1]。但此病不是肝病的終末期,如果能夠及時干預,病情有可能好轉[2]。國內(nèi)外專家進行了大量研究,從單因素分析到多因素分析,相繼建立了多種評估肝病預后的模型,但目前并沒有評價HBV-ACLF預后的特異性評分或模型。各模型在臨床上的運用及受到的評價褒貶不一。本研究選取了已得到頻繁應用、在歐美人群數(shù)據(jù)建立起的兩個模型,終末期肝病模型聯(lián)合血清鈉(MELD-Na)及慢性肝衰竭-序貫器官衰竭評估(CLIF-SOFA)評分,以及近年新建立的針對亞洲ACLF人群研究的亞太肝臟研究協(xié)會慢加急性肝衰竭研究小組(AARC-ACLF)評分。由于東西方肝病患者肝臟損傷病因不同,ACLF診斷標準、預后判斷等均有明顯差異[3-4]。我國ACLF的定義與APASL專家共識基本一致,但AARC-ACLF目前尚未在我國臨床工作中廣泛應用,上述評分系統(tǒng)是否適于我國HBV-ACLF患者需要進一步討論研究。本研究將進一步探索比較MELD-Na、CLIF-SOFA、AARC-ACLF對預測HBV-ACLF患者短期預后的診斷價值。方法選取72例HBV-ACLF患者,根據(jù)從診斷ACLF至診斷后3個月時的預后分為2組,經(jīng)內(nèi)科治療病情穩(wěn)定或好轉為A組(29例),治療無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時的臨床資料,選取患者同期臨床指標,比較2組的年齡(Age)、凝血酶原時間(PT)、國際標準化比值(INR)、凝血酶原活動度(PTA)、總膽紅素(TBIL)、甲胎蛋白(AFP)、血氨(NH3)、血清肌酐(Cr)、動脈血中的酸堿度(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)評價上述評分系統(tǒng)對ACLF短期預后診斷的預測價值。結果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)計學意義(P0.05)。兩組的Age、Cr、ALB、CHE、AFP、NH3、PH、LAC、MAP,無明顯統(tǒng)計學差異。3種評分系統(tǒng)的AUC均大于0.7,提示診斷價值中等。CLIF-SOFA評分曲線下面積(AUC 0.887)優(yōu)于MELD-Na評分的曲線下面積(AUC 0.764),差異有統(tǒng)計學意義(Z 2.255,P0.0167),CLIF-SOFA和AARC-ACLF評分的曲線下面積(AUC分別為0.887、0.825)、MELD-Na和AARC-ACLF評分的曲線下面積(AUC分別為0.764、0.825)差異均無統(tǒng)計學意義(Z分別為1.361、1.127,P0.0167),MELD-Na、CLIF-SOFA、AARC-ACLF評分所得最佳臨界值分別為23.84、8.50、8.50。結論3種評分系統(tǒng)均能較好地預測乙型肝炎相關慢加急性肝衰竭患者的短期臨床預后,AARC-ACLF評分系統(tǒng)的研究基礎是亞洲人群,所需相關指標方便獲得,計算過程簡單,臨床應用價值更高。
[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.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R512.62;R575.3
本文編號：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.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R512.62;R575.3
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