HBV相关慢加急性肝衰竭预后简易评分系统的建立

A simple scoring system for evaluating severity of HBV-related acute-on-chronic liver failure

目的：建立 HBV 相关慢加急性肝衰竭（HBV -ACLF）严重度简易评分系统。方法收集620例 HBV -ACLF 患者的临床资料，选择肝性脑病、血清肌酐、血清总胆红素、凝血酶原活动度、感染、肝脏大小、腹水液平等7个临床指标，应用统计学方法并结合临床实际，确定各指标从0～4分评分界点，并累计总分。据此建立模型并确定诊断界点，对此评分模型进行验证。结果对HBV -ACLF 患者临床资料进行统计学分析，交互卡方检验确定各指标评分分值并建立模型。将500例患者分为生存组和死亡组。两组间评分差异有统计学意义（t ＝25．78，P ＜0．001）。受试者工作特征曲线（ROC 曲线）下面积0．963，最佳临界值9．5，灵敏度0.98，特异度0．83。120例患者对其进行验证，≥10分预后差，病死率为84．3％，≤9分组预后好，病死率为3．5％。两组病死率比较差异有统计学意义（χ^2＝72．2，P ＜0．001）。结论本评分系统可用于 HBV -ACLF 预后评估，具有简易、敏感、客观的优点。

Objective To establish a simple scoring system for evaluating the severity of hepatitis B virus （HBV）-related acute -on -chronic liver failure （HBV -ACLF）.Methods A retrospective analysis was performed on the clinical data of 620 patients with HBV -ACLF who were divided into group I （500 patients）and group II （120 patients）.Seven clinical parameters,including hepatic encephalopa-thy,serum creatinine,prothrombin activity,serum total bilirubin,infection,dimension of liver,and maximum depth of ascites,were scored from 0 -4 points for each patient according to the disease severity.The severity scoring system was established based on the total score of each patient in group I,with the cut -off point being determined.The established system was tested with group II.Results A severity sco-ring system was successfully developed based on chi -squared automatic interaction detector analysis of the total score of each patient in group I.There was a significant difference in the total score between the survival and death subgroups of the 500 patients （t =25.78,P 〈0.001）.The area under the ROC curve was 0.963,suggesting a high validity of this scoring system.With the cut -off value of 9.5,the sensitivity and specificity of this system were 0.98 and 0.83,respectively.The other 120 patients were divided into the poor prognosis （score ≥10）and good prognosis subgroups （score ≤9）based on the scoring system,with the mortality rates being 84.3% and 3.5%,re-spectively;there was a significant difference in mortality between the two subgroups （χ2 =72.2,P ＆lt;0.001 ）.Conclusion This scoring system is simple,sensitive,and objective to evaluate the severity of HBV -ACLF.