早期凝血酶原活动度对预测慢性乙型肝炎慢加急性肝衰竭预后的价值

The value of early prothrombin activity for predicting the prognosis of acute - on - chronic hepatitis B liver failure

目的探讨早期凝血酶原活动度（PTA）对预测慢性乙型肝炎（CHB）慢加急性肝衰竭患者预后的价值。方法分析156例CHB相关慢加急性肝衰竭患者3个月的预后，根据临床结局分为生存组和死亡组，分析两组患者在基线、1周及2周时的PTA及终末期肝病模型（MELD）评分的差异，应用受试者工作特征曲线（ROC曲线）评估基线、1周及2周时的PTA、MELD评分对预后判断的价值。结果在156例患者中有58例死亡，病死率为37．18％。生存组与死亡组患者的PTA（％）比较，在基线、1周及2周时分别为：31．49±7．22vs25．44±8．10、37．56±11．72vs24．22±11，22及49．28±20．82vs23．08±7．43，差异均有统计学意义（P均〈0．05）；生存组与死亡组患者的MELD评分比较，在基线、1周及2周时分别为：25．53±4．61vs28．56±6．39、24．21±4．64vs31．07±6．03及20．06±5．06vs31．77±6．33，差异均有统计学意义（P均〈0．05）。在基线、1周及2周时PTA、MELD评分的ROC曲线下面积（AUC）比较中，2周时PTA的AUC最大（0．957），其次为2周时MELD评分的AUC（0．938），但两者比较差异无统计学意义（P=0．405）；2周时PTA的最佳临界值为35．55％，敏感度为96．60％，特异度为80．40％。2周时，PTA〈20％的3个月病死率为100％；20％≤PTA〈35％为70．81％；35％≤PTA〈50％为4．17％；PTA≥50％的均存活。VIA越低，病死率越高，线性趋势检验χ2=85．70，P〈0．001。结论慢性乙型肝炎慢加急性肝衰竭患者治疗2周时的PTA可作为其3个月预后的早期预测指标。

Objective To study the prognostic value of early prothrombin activity levels in patients with acute - on - chronic hepatitis B liver failure. Methods One hundred and fifty - six patients with acute - on - chronic hepatitis B liver failure were divided into survival group and dead group according to the prognosis of three months. The prothrombin activity （PTA） and the model for end - stage liver disease （MELD） score at baseline, firstweek and secondweek were compared between two groups respectively, and the receiver operating characteristic curves （ROC curves） were used to assess the prognostic value of PTA and MELD score at baseline, first week and second week respectively. Results Of the 156 patients, 58 died, and the mortality rate was 37.18%. The significant differences in PTA（ % ） level were observed between survival group and dead group at the baseline, first week and seeond week （25.53±4.61 vs 28.56± 6.39 and P 〈 0.05, 24.21 ±4.64 vs 31.07± 6.03 and P 〈 0. 05, 49.28 ± 20.82 vs 23.08± 7.43 and P 〈 0.05, respectively）. There were significant differences in MELD score between survival group and dead group at baseline, first week and second week（25.53 ±4.61 vs 28.56 ±6.39 and P 〈0.05, 24.21 ±4.64 vs 31.07±6.03 and P 〈0.05, 20.06± 5.06 vs 31.77 ±6.33 and P 〈0.05, respectively）. The areas under the ROC curve （AUC） of the PTA at the second weekwas the largest （0.957）, and AUC of the MELD score was the second largest, but there was no significant difference between them （P =0.405 ）. The cut - off values of the PTA at second week was 35.55%, and the sensitivity was 96.60% and the specificity was 80.40%. The 3 - month mortality rate of the VIA at second Week group PTA 〈20%, 20% ≤〈PTA 〈35% and 35% ≤PTA 〈50% were 100%, 70.81% and 4.17% respectively, and the group PTA≥50% were all alive, and the linear trend test showed χ2 = 85.70, P 〈 0. 001. Conclusion The PTA after 2 - week treatment is an early and useful predictor for 3 - month mortality in patients with acute - on - chronic hepatitis B liver failure.