血清前白蛋白和MELD评分对失代偿期乙型肝炎肝硬化患者预后的预测价值

Predictive efficacy of serum prealbum in combined with model of end-stage liver disease score in the prognosis of patients with decom pensated hepatitis B-induced liver cirrhosis

目的研究应用血清前白蛋白(PA)水平联合终末期肝病模型(MELD)评分预测失代偿期乙型肝炎肝硬化患者预后的临床价值。方法 2015年12月～2016年12月我院治疗的失代偿期乙型肝炎肝硬化患者231例,随访6个月。常规检测血清PA水平、计算MELD评分和Child-Pugh评分(CTP评分),在MELD评分的基础上,加入PA项目的评分,建立MELD联合PA评分模型。应用受试者工作特征曲线(ROC)分析各指标对患者死亡的预测效能。结果在随访的6个月里,死亡83例;死亡组血清PA水平为(32.2±9.3)mg/L,显著低于生存组的[(47.3±26.4)mg/L,P<0.05];死亡组MELD评分为(24.1±5.6)分,明显高于生存组的[(18.0±6.7)分,P<0.05];死亡组CTP评分为(11.8±1.2)分,明显高于生存组的[(9.0±2.0)分,P<0.05];ROC曲线分析结果显示,MELD评分预测死亡的ROC下面积(AUC)为0.868(95%CI:0.823～0.912),显著高于CTP评分的[0.753(95%CI:0.690～0.816),P<0.05]或血清PA的[0.675(95%CI:0.606～0.743),P<0.05];进一步采用MELD联合PA评分分析的AUC为0.896(95%CI:0.857～0.935),显著高于MELD评分(P<0.05)。结论应用血清PA联合MELD评分对失代偿期乙型肝炎肝硬化患者6个月内死亡的预测效能显著高于MELD评分或CTP评分,其临床应用价值还需要扩大验证。

Objective To investigate the predictive efficacy of serum prealbumin（PA）combined with modelof end-stage liver disease （MELD）score in the prognosis of patients with decompensated hepatitis B-induced livercirrhosis. Methods 231 patients with decompensated liver cirrhosis and hepatitis B were recruited in our hospitalbetween December 2015 and December 2016, and all of them were followed-up for six months. Serum PA levelswere collected and the MELD score and CTP score were calculated, and MELD/PA model was established. Thearea under curve of receiver operating characteristic （AUC）was applied to estimate the efficacy of prognosis.Results A total of 83 patients died during the 6-month follow-up period; serum PA content in the dead groupwas （32.2±9.3）mg/L, significantly lower than[ （47.3±26.4） mg/L, P〈0.05] in the survival group; the MELD score was（24.1 ±5.6）, significantly higher than [ （18.0 ±6.7）, P〈0.05] in the survival; the CTP score was （11.8 ±1.2）,significantly higher than [ （9.0±2.0）, P〈0.05] in the survival; the ROC analysis showed that the AUC of MELDscore was 0.868 （95%CI：0.823-0.912）, much higher than [0.753（95%CI：0.690-0.816）, P〈0.05] by CTP score, or[0.675（95%CI：0.606-0.743）, P〈0.05] by serum PA; further comparison analysis result showed that the AUC ofMELD/PA score was 0.896 （95%CI：0.857 -0.935）, significantly higher than by MELD （P〈0.05） . Conclusion Theapplication of serum PA levels combined with MELD score in predicting the 6 month prognosis of patients withdecompensated hepatitis B liver cirrhosis is feasible, which needs further investigation.