血浆渗透压评分对肝肾综合征的预后评价

Plasma osmotic pressure score in predicting prognosis of patients with hepatorenal syndrome

目的探讨血浆渗透压评分对肝肾综合征(hepatorenal syndrome HRS)预后的评价作用。方法研究对象为106例HRS患者,按随访3月内的预后情况分为存活组(30例)和死亡组(76例),分别进行血浆有效晶体渗透压评分、胶体渗透压评分、血浆渗透压综合评分、终末期肝病模型(model for end-stage liver disease MELD)评分和Child-Pugh评分,进行统计学分析,比较各评分对HRS预后的评价能力。结果 除血浆有效晶体渗透压评分外,HRS死亡组的其余各评分均显著高于存活组(P<0.01)。Child-Pugh、MELD和血浆渗透压综合评分的曲线下面积(area under curve AUC)均>0.7,其余各项评分的AUC均<0.7。Youden指数以血浆渗透压综合评分为最高,MELD和Child-Pugh评分次之。结论 Child-Pugh、MELD和血浆渗透压综合评分对HRS预后均具有良好的评价作用,其中以血浆渗透压综合评分的预测能力最佳。

Objective To investigate the usefulness of the plasma osmotic pressure score in predicting prognosis of patients with hepatorenal syndrome （HRS）. Methods A total of 106 patients enrolled in the study were divided into a survival group （30 cases） and a death group （76 cases） by the prognosis in a 3-month follow-up. Five scores were performed： plasma crystal osmotic pressure score, plasma colloid osmotic pressure score, total plasma osmotic pressure score （the two combined）, model for end-stage liver disease （MELD） score and Child-Pugh score and these scores were compared in terms of reliability when used to predict the prognosis of HRS. Resuits The values for the death group evaluated by all but the crystal osmotic pressure score were significantly higher than those for the survival group（P 〈0.01 ）. The area under curve（AUC）values of the Child-Pugh score, the MELD score and the total plasma osmotic pressure score were all above 0.7, while those of the other two scores were both below 0.7. The Youden＇s indexes were in the order of the total plasma osmotic pressure score 〉 the MELD score 〉 the Child-Pugh score. Conclusions The total plasma osmotic pressure score, the MELD score and the Child-Pugh score can reliably predict prognosis of HRS patients, with the total plasma osmotic pressure score showing the best correlation with prognosis.