AFP和PTA水平對ACLF患者預(yù)后的預(yù)測價值研究
發(fā)布時間：2018-11-16 16:28
【摘要】：背景慢加急性肝衰竭(ACLF)是肝衰竭中最常見的一類,它是依據(jù)肝臟組織病理學(xué)特征和病情發(fā)展速度的快慢而分類的。ACLF的預(yù)后普遍較差,肝臟移植是目前根治各種終末期肝病、挽救患者生命的有效手段。早期快速準(zhǔn)確的預(yù)測ACLF患者的預(yù)后對臨床治療有重要的指導(dǎo)意義,從而幫助臨床醫(yī)生正確而快速的診治該疾病。臨床上有很多指標(biāo)可以用來判斷ACLF患者的預(yù)后,國內(nèi)外關(guān)于單項血清甲胎蛋白(AFP)和單項血漿凝血酶原活動度(PTA)對于ACLF患者預(yù)后判斷的意義均有大量報道,但兩者聯(lián)合報道卻寥寥無幾。目的評價血清AFP聯(lián)合血漿PTA在ACLF患者中的應(yīng)用價值。方法采用回顧性分析方法,選取自2013年1月至2016年1月南陽市中心醫(yī)院收治的符合ACLF診斷標(biāo)準(zhǔn)的95例患者作為研究對象,根據(jù)預(yù)后將95例ACLF患者分為好轉(zhuǎn)組(49例)和無效組(46例),通過Microsoft Excel 2010軟件構(gòu)建數(shù)據(jù)庫,借助SPSS 17.0進(jìn)行統(tǒng)計分析,通過卡方檢驗來分析定性資料數(shù)據(jù),通過t檢驗來分析定量資料數(shù)據(jù)。同時,針對具備意義的因素,通過Logistic回歸分析對其展開深入研究,將關(guān)系到慢加急性肝衰竭病人預(yù)后的獨立危險因素篩選出來。比較好轉(zhuǎn)組和無效組AFP、PTA的差異,以及兩組患者AFP和PTA的不同水平間的比較。采用受試者工作特征曲線(ROC)下面積(AUC)評估AFP和PTA對ACLF患者預(yù)后的預(yù)測價值。結(jié)果1.經(jīng)單因素分析篩選出對影響ACLF患者預(yù)后有影響意義的因素有年齡、凝血酶原時間(PT)、PTA、總膽紅素(TBIL)、白蛋白(ALB)、AFP,其中P0.05。2.通過多因素Logistic回歸分析對以上具備影響作用的指標(biāo)加以分析,將對ACLF預(yù)后產(chǎn)生作用的獨立危險因素篩選出來,僅PTA和AFP兩項差異有統(tǒng)計學(xué)意義,其中P0.01。3.好轉(zhuǎn)組與無效組AFP和PTA比較差異均有統(tǒng)計學(xué)意義(P0.01),好轉(zhuǎn)組明顯高于無效組。在AFP和PTA的不同水平上,好轉(zhuǎn)組與無效組的發(fā)生率差異有統(tǒng)計學(xué)意義(P0.01)。研究對象受試者工作特征曲線(ROC)分析顯示,采用AFP≥80.025μg/L聯(lián)合PTA≥32.100%來預(yù)測ACLF的結(jié)局,曲線下面積(AUC)為0.989,敏感度為91.8%,特異度為100%。結(jié)論1.肝細(xì)胞壞死愈重,AFP水平愈低,AFP血清水平值與肝細(xì)胞壞死程度呈正相關(guān),而且可以是獨立的預(yù)測指標(biāo);肝細(xì)胞壞死愈重,PTA下降愈明顯,PTA降低程度與肝細(xì)胞壞死的嚴(yán)重程度呈正相關(guān),而且可以是獨立的預(yù)測指標(biāo)。2.血清AFP和血漿PTA是預(yù)測ACLF患者預(yù)后的重要指標(biāo),采用AFP聯(lián)合PTA能更準(zhǔn)確地預(yù)測ACLF患者的預(yù)后,且特異性更高。
[Abstract]:Background chronic and acute hepatic failure (ACLF) is the most common type of liver failure, which is classified according to the histopathological characteristics of liver and the speed of progression. The prognosis of ACLF is generally poor. Liver transplantation is an effective way to cure all kinds of end-stage liver diseases and save patients' lives. Early rapid and accurate prediction of the prognosis of ACLF patients has important guiding significance for clinical treatment, so as to help clinicians correct and rapid diagnosis and treatment of the disease. There are many clinical indicators to judge the prognosis of ACLF patients. There are a lot of reports on the significance of single serum alpha-fetoprotein (AFP) and plasma prothrombin activity (PTA) in judging the prognosis of ACLF patients at home and abroad. But there are few joint reports of the two. Objective to evaluate the value of serum AFP combined with plasma PTA in ACLF patients. Methods from January 2013 to January 2016, 95 patients admitted to Nanyang Central Hospital who met the diagnostic criteria of ACLF were selected as the study objects. According to the prognosis, 95 patients with ACLF were divided into two groups: improvement group (49 cases) and ineffective group (46 cases). The database was constructed by Microsoft Excel 2010 software and analyzed by SPSS 17.0. Qualitative data were analyzed by chi-square test. The quantitative data were analyzed by t-test. At the same time, the significant factors were studied by Logistic regression analysis, and the independent risk factors related to the prognosis of patients with chronic and acute hepatic failure were screened out. The difference of AFP,PTA between the improved group and the ineffective group, as well as the comparison of AFP and PTA levels between the two groups were compared. The area (AUC) under the operating characteristic curve (ROC) was used to evaluate the prognostic value of AFP and PTA in ACLF patients. Result 1. Age and prothrombin time of (PT), PTA, total bilirubin (TBIL), albumin (ALB), AFP, were selected by univariate analysis. The independent risk factors for the prognosis of ACLF were screened by multivariate Logistic regression analysis. Only PTA and AFP had statistical significance (P0.01.3). There were significant differences in AFP and PTA between the improved group and the ineffective group (P0.01), and the improvement group was significantly higher than the ineffective group. At the different levels of AFP and PTA, there was significant difference between the improvement group and the ineffective group (P0.01). (ROC) analysis showed that AFP 鈮，
本文編號：2336020
[Abstract]:Background chronic and acute hepatic failure (ACLF) is the most common type of liver failure, which is classified according to the histopathological characteristics of liver and the speed of progression. The prognosis of ACLF is generally poor. Liver transplantation is an effective way to cure all kinds of end-stage liver diseases and save patients' lives. Early rapid and accurate prediction of the prognosis of ACLF patients has important guiding significance for clinical treatment, so as to help clinicians correct and rapid diagnosis and treatment of the disease. There are many clinical indicators to judge the prognosis of ACLF patients. There are a lot of reports on the significance of single serum alpha-fetoprotein (AFP) and plasma prothrombin activity (PTA) in judging the prognosis of ACLF patients at home and abroad. But there are few joint reports of the two. Objective to evaluate the value of serum AFP combined with plasma PTA in ACLF patients. Methods from January 2013 to January 2016, 95 patients admitted to Nanyang Central Hospital who met the diagnostic criteria of ACLF were selected as the study objects. According to the prognosis, 95 patients with ACLF were divided into two groups: improvement group (49 cases) and ineffective group (46 cases). The database was constructed by Microsoft Excel 2010 software and analyzed by SPSS 17.0. Qualitative data were analyzed by chi-square test. The quantitative data were analyzed by t-test. At the same time, the significant factors were studied by Logistic regression analysis, and the independent risk factors related to the prognosis of patients with chronic and acute hepatic failure were screened out. The difference of AFP,PTA between the improved group and the ineffective group, as well as the comparison of AFP and PTA levels between the two groups were compared. The area (AUC) under the operating characteristic curve (ROC) was used to evaluate the prognostic value of AFP and PTA in ACLF patients. Result 1. Age and prothrombin time of (PT), PTA, total bilirubin (TBIL), albumin (ALB), AFP, were selected by univariate analysis. The independent risk factors for the prognosis of ACLF were screened by multivariate Logistic regression analysis. Only PTA and AFP had statistical significance (P0.01.3). There were significant differences in AFP and PTA between the improved group and the ineffective group (P0.01), and the improvement group was significantly higher than the ineffective group. At the different levels of AFP and PTA, there was significant difference between the improvement group and the ineffective group (P0.01). (ROC) analysis showed that AFP 鈮，
本文編號：2336020
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