对血小板与胆红素乘以国际标准化比率的比值预测重型肝炎转归的验证

Verification of the prediction outcome of the ratio of platelet and bilirubin multiplied by the international for prognosis of severe hepatitis

目的验证血小板与胆红素乘以凝血酶原时间国际标准化比率的比值模型(PBI)对重型肝炎转归的预测价值。方法回顾性应用PBI和终末期肝病模型(MELD)测算两家医院住院的重型肝炎病例,其中好转存活组患者64例,恶化死亡组患者50例,计算两组病例住院初期、中期、末期的PBI和MELD分值,比较两组患者各期PBI、MELD分值的变化和诊断患者恶化死亡的ROC曲线下面积。结果好转存活组与恶化死亡组在住院初期、中期、末期,PBI计分的均值分别为(19.22±17.83)与(10.36±13.97)、(32.72±29.20)与(7.26±6.25)、(114.22±144.75)与(5.34±4.58),同期比较差异均具有统计学意义(P均<0.01)。MELD计分的均值分别为(24.28±4.82)与(31.14±7.28)、(20.97±5.85)与(30.96±8.85)、(16.50±5.71)与(34.50±10.32),差异均具有统计学意义(P均<0.01)。好转存活组与恶化死亡组患者的PBI和MELD分值变化趋势均呈反向;住院初期、中期、末期,PBI和MELD分值诊断患者恶化死亡的ROC曲线下面积分别为0.731和0.791,0.818和0.795,0.979和0.887;住院初期,PBI与MELD最佳临界点值预测恶化死亡的敏感度分别为72.00%与80.00%,特异度分别为70.31%与67.19%,准确度分别为71.05%与72.81%,阳性预测值分别为65.45%与65.57%,阴性预测值分别为76.27%与81.13%。结论 PBI分值的变化能够良好地反映重型肝炎好转存活与恶化死亡的转变规律,依据PBI变化趋势能良好地预测重型肝炎的临床转归。

Objective To investigate the value of model of ratio on platelet（PLT） divided by the product of bilirubin（TBil） and prothrombin international normalized ratio（PBI） for the prognosisi of severe hepatitis. The ratio of platelet and bilirubin, international normalized ratio was equal to the PLT/（TBil × INR）. Methods The severe hepatitis cases in two different hospitals were measured by retrospective application of PBI and the model for end-stage liver disease（MELD）, which including 64 cases of survival group and 50 cases of deteriorated group. The PBI and MELD score of patients in the two groups in early, middle, late for hospitalized were analyzed. The PBI score, the MELD score and area under the curve（AUC） of receiver operating characteristics（ROC） for the degradation rate were compared between the two groups. Results The mean of PBI score of survival group and death group during the initial hospitalization, deterioration in the intermediate and the end stage were（19.22 ± 17.83） and（10.36 ± 13.97）,（32.72 ± 29.20） and（7.26 ± 6.25）,（114.22 ± 144.75） and（5.34 ± 4.58）, respectively; all with significant differences compared to the same period（P all 〈0.01）. The mean MELD score were（24.28 ± 4.82） and（ 31.14 ± 7.28）,（20.97 ± 5.85） and（30.96 ± 8.85）,（16.50 ± 5.71） and（34.50 ± 10.32）, all with significant differences compared to the same period（P all 〈0.01）. Improved survival group and death group, the change tendency of PBI score and MELD score were reverse. During the early, intermediate and end stages of hospitalization, PBI score and MELD score in the diagnosis of patients with worsening ROC curve area of death were 0.731 and 0.791, 0.818 and 0.795, 0.979 and 0.887, respectively. During the early hospitalization period, the best critical point between the PBI and MELD score used to be predicted the sensitivity of deteriorating death, which were 72.00% and 80.00%, respectively; the specificity were 70.31% and 67.19%, the accuracy were 71.05% and 72.81%, the positive predicative value were 65.45% and 65.57%, and besides the negative predicative value were 76.27% and 81.13%. Conclusions PBI score variation show change law in the improved survival patients with fulminant hepatitis and the deterioration of death patients with severe hepatitis. Clinical outcomes according to PBI trends could be a good way to predict severe hepatitis.