失代償期肝硬化預(yù)后危險因素分析及相關(guān)預(yù)后模型比較的研究
發(fā)布時間：2018-10-10 17:13
【摘要】：【目的】 研究影響失代償期肝硬化患者預(yù)后的危險因素。比較Child-Pugh分級、終末期肝病模型（MELD評分）及MELD-Na評分、Cr-Child評分這四種肝硬化預(yù)后模型的預(yù)測價值，幫助臨床醫(yī)生準(zhǔn)確判斷失代償肝硬化患者的預(yù)后轉(zhuǎn)歸，對臨床選擇有效的治療方法具有重要的指導(dǎo)價值。 【方法】 1.選擇2010年1月至2013年12月入住我院消化科的231例確診失代償期肝硬化患者作為研究對象，采用回顧性隨訪調(diào)查研究，制定病史資料登記表，記錄每例研究對象的基本情況、病史、實驗室檢查及影像學(xué)檢查信息，采用電話隨訪的方式進行隨訪，記錄研究對象3個月的事件結(jié)局。將資料錄入Microsoft Excel2007forWindows，建立數(shù)據(jù)庫，采用SPSS17.0for Windows軟件進行統(tǒng)計學(xué)處理。其中定量資料使用t檢驗，定性資料使用卡方檢驗，采用單因素及多因素Logistic回歸分析方法，得出相應(yīng)的獨立危險因素。 2.選擇方法1中的臨床資料作為比較Child-Pugh分級、MELD評分、MELD-Na評分、Cr-Child評分這四種預(yù)后模型的分析樣本。通過計算受試者工作特征曲線（ROC）的曲線下面積（AUC），比較其預(yù)測價值。 【結(jié)果】 1.單因素Logistic分析：上消化道出血、WBC、ALB、Cys C、HDL、Na、A/G是影響預(yù)后的因素，其中上消化道出血、Cys C與患者死亡風(fēng)險呈正相關(guān)（P 0.05），，WBC、ALB、HDL、Na、A/G與患者死亡風(fēng)險呈負(fù)相關(guān)（P 0.05），其余指標(biāo)差異無統(tǒng)計學(xué)意義（P0.05）。 2.多因素Logistic分析影響失代償期肝硬化預(yù)后的獨立危險因素為：ALB、Na。血清ALB和Na濃度預(yù)測死亡的ROC曲線下面積分別為0.867、0.904，與0.5相比差異有統(tǒng)計學(xué)意義（P 0.001）。 3. MELD-Na評分、MELD評分、Child-Pugh分級、Cr-Child評分的ROC曲線下面積（AUC）分別為0.812（95%CI0.715-0.909）、0.802（95%CI0.703-0.901）、0.783（95%CI0.618-0.885）和0.732（95%CI0.621-0.843）。MELD-Na評分在預(yù)測失代償期肝硬化患者短期預(yù)后方面明顯優(yōu)于Child分級、MELD評分及Cr-Child評分。 【結(jié)論】 血清ALB和Na濃度是影響失代償期肝硬化短期預(yù)后的獨立危險因素，血鈉水平對肝硬化患者預(yù)后具有較高的預(yù)測價值。 MELD-Na評分的預(yù)測價值明顯優(yōu)于Child-Pugh分級、MELD評分及Cr-Child評分這三種預(yù)后模型，具有客觀性、穩(wěn)定性等優(yōu)點，推薦臨床普遍使用。
[Abstract]:Objective to study the prognostic factors of decompensated cirrhosis. To compare the predictive value of Child-Pugh grade, end-stage liver disease model (MELD), MELD-Na score and Cr-Child score in predicting the prognosis of patients with decompensated cirrhosis, and to help clinicians accurately judge the prognosis of patients with decompensated cirrhosis. It has important guiding value for clinical selection of effective treatment methods. [methods] 1. From January 2010 to December 2013, 231 patients with decompensated cirrhosis who were admitted to the Department of Digestive Medicine in our hospital were selected as the study subjects. History, laboratory and imaging information were followed up by telephone, and the outcome of 3 months was recorded. Data input into Microsoft Excel2007forWindows, to establish a database, using SPSS17.0for Windows software for statistical processing. T test was used for quantitative data, chi-square test was used for qualitative data, and independent risk factors were obtained by single factor and multivariate Logistic regression analysis. 2. The clinical data in method 1 were selected as the analysis samples of four prognostic models: Child-Pugh grade, MELD score, MELD-Na score and Cr-Child score. The area under the curve of the operating characteristic curve (ROC) was calculated to compare its predictive value. [results] 1. Univariate Logistic analysis showed that upper gastrointestinal hemorrhage and WBC,ALB,Cys HDL Logistic / A / G were the prognostic factors. There was a positive correlation between, Cys C and death risk in patients with upper gastrointestinal hemorrhage (P 0.05), a negative correlation between WBC,ALB,HDL,Na,A/G and death risk (P 0.05), and no significant difference in other indexes (P0.05). The independent risk factors for the prognosis of decompensated cirrhosis by multivariate Logistic analysis were as follows: ALB,Na. The area under the ROC curve of serum ALB and Na was 0.8670.904, which was significantly higher than that of Na (P 0.001). The area under ROC curve of MELD-Na score, MELD score, Child-Pugh grade and Cr-Child score were 0.812 (95%CI0.715-0.909), 0.802 (95%CI0.703-0.901), 0.783 (95%CI0.618-0.885) and 0.732 (95%CI0.621-0.843) respectively. MELD-Na score was superior to Child grade, MELD score and Cr-Child score in predicting short-term prognosis of decompensated cirrhosis patients. [conclusion] Serum ALB and Na levels are independent risk factors for short-term prognosis of decompensated cirrhosis. The value of MELD-Na score is better than that of Child-Pugh grade, MELD score and Cr-Child score, which has the advantages of objectivity and stability. General clinical use is recommended.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R575.2
本文編號：2262612
[Abstract]:Objective to study the prognostic factors of decompensated cirrhosis. To compare the predictive value of Child-Pugh grade, end-stage liver disease model (MELD), MELD-Na score and Cr-Child score in predicting the prognosis of patients with decompensated cirrhosis, and to help clinicians accurately judge the prognosis of patients with decompensated cirrhosis. It has important guiding value for clinical selection of effective treatment methods. [methods] 1. From January 2010 to December 2013, 231 patients with decompensated cirrhosis who were admitted to the Department of Digestive Medicine in our hospital were selected as the study subjects. History, laboratory and imaging information were followed up by telephone, and the outcome of 3 months was recorded. Data input into Microsoft Excel2007forWindows, to establish a database, using SPSS17.0for Windows software for statistical processing. T test was used for quantitative data, chi-square test was used for qualitative data, and independent risk factors were obtained by single factor and multivariate Logistic regression analysis. 2. The clinical data in method 1 were selected as the analysis samples of four prognostic models: Child-Pugh grade, MELD score, MELD-Na score and Cr-Child score. The area under the curve of the operating characteristic curve (ROC) was calculated to compare its predictive value. [results] 1. Univariate Logistic analysis showed that upper gastrointestinal hemorrhage and WBC,ALB,Cys HDL Logistic / A / G were the prognostic factors. There was a positive correlation between, Cys C and death risk in patients with upper gastrointestinal hemorrhage (P 0.05), a negative correlation between WBC,ALB,HDL,Na,A/G and death risk (P 0.05), and no significant difference in other indexes (P0.05). The independent risk factors for the prognosis of decompensated cirrhosis by multivariate Logistic analysis were as follows: ALB,Na. The area under the ROC curve of serum ALB and Na was 0.8670.904, which was significantly higher than that of Na (P 0.001). The area under ROC curve of MELD-Na score, MELD score, Child-Pugh grade and Cr-Child score were 0.812 (95%CI0.715-0.909), 0.802 (95%CI0.703-0.901), 0.783 (95%CI0.618-0.885) and 0.732 (95%CI0.621-0.843) respectively. MELD-Na score was superior to Child grade, MELD score and Cr-Child score in predicting short-term prognosis of decompensated cirrhosis patients. [conclusion] Serum ALB and Na levels are independent risk factors for short-term prognosis of decompensated cirrhosis. The value of MELD-Na score is better than that of Child-Pugh grade, MELD score and Cr-Child score, which has the advantages of objectivity and stability. General clinical use is recommended.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R575.2
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