终末期肝病模型评分联合平均血小板体积评估在乙型肝炎相关慢加急性肝衰竭患者短期预后评估中的价值

Predictive value of model for end-stage liver disease scores combined with mean platelet volume on the short-term prognosis of patients with acute-on-chronic hepatitis B liver failure

目的探讨终末期肝病模型（MELD）评分联合平均血小板体积（MPV）预测乙型肝炎慢加急性肝衰竭（ACLF）患者短期预后的临床价值。方法选取2012年1月~2015年12月就诊于昆明市第三人民医院及云南省第三人民医院的乙型肝炎相关ACLF患者331例,根据随访3个月的结果分为生存组（208例）和死亡组（123例）,记录并比较两组患者的血清总胆红素（TBIL）、肌酐（Cr）、国际标准化比值（INR）、血清钠（Na＋）、MPV和MELD评分。结果死亡组的血清TBIL、Cr、INR、MPV、MELD评分均高于生存组,血清Na＋水平低于生存组,差异均有高度统计学意义（均P〈0.01）。MELD评分、MPV预测乙型肝炎相关ACLF患者近期死亡危险性的最佳临界值分别为24.8、9.5 f L。MELD评分联合MPV判断乙型肝炎相关ACLF 3个月内预后的AUC为0.880,高于单独MELD评分（0.820）和单独MPV检测（0.803）,差异均有高度统计学意义（均P〈0.01）。结论 MELD评分联合MPV对乙型肝炎相关ACLF患者短期预后的预测价值良好。

Objective To investigate the predictive value of MELD combined with MPV on the short-term prognosis in patients with ACHBLF. Methods A total of 331 patients with ACHBLF, admitted by the Third People＇s of Yunnan Province and the Third People＇s Hospital of Kunming from January 2012 to December 2015, were divided into survival group（208 cases） and death group（123 cases） according to the results of followed-up for 3 months. Serum total bilirubin（TBIL）, creatinine（Cr）, international normalized ratio（INR）, MPV, MELD scores of two groups were recorded and compared. Results The serum levels of TBIL, Cr, Na＋and MPV, INR, and the scores of MELD were significantly higher in the death group than those in the survival group, while the serum level of Na＋was significantly lower in the death group than that in the survival group, the differences were statistically significant（all P〈0.01）. The optimal cut-off scores of MELD, and serum level of MPV were 24.8 and 9.5 f L. The AUC of MELD score with MPV was 0.880, which was higher than only by MELD score（0.820） and only by MPV（0.803） within 3-months for patients with ACHBLF.Conclusion MELD score combined with MPV has a good predictive value on the short-term prognosis in patients with ACHBLF.