终末期肝病模型评分联合吲哚菁绿清除实验预测HBV相关慢加急性肝衰竭预后

Model for End-Stage Liver Disease Combined with Indocyanine Green Clearance Test Can Effectively Predict the Prognosis of HBV-Associated Acute-On-Chronic Liver Failure

【目的】探讨终末期肝病模型(MELD)评分联合吲哚菁绿清除实验(ICG)对HBV相关慢加急性肝衰竭(ACLF)短期预后评估。【方法】回顾性分析2017年6月至2017年12月中山大学附属第三院感染科住院收治的HBV相关ACLF患者共138例,临床确诊为HBV相关ACLF,24 h内予吲哚菁绿,记录15 min滞留率(ICGR_(15))及有效肝脏血流量(EHBF)值,同时记录24 h内临床各项指标。建立ICGR_(15) min滞留率转换模型(ICGR_(15)Score),并应用MELD评分联合ICGR_(15)Score,MELD评分、ICGR15滞留率,EHBF及Child-Pugh评分预测入组病例28 d生存率。根据ROC曲线下的面积(AUC)比较各评分系统对HBV相关ACLF预后预测敏感性和特异性,P<0.05差异有统计学意义。【结果】纳入病例存活组与死亡组比较:死亡组患者的年龄大于生存组(P=0.011),同时临床资料比较分析显示:TBi(lP<0.001),DBi(lP<0.001),PT(P<0.001),PTA(P<0.001),CREA(P=0.008),ICGR_(15) Score(P=0.002),MELD评分(P<0.001),CTP分级(P=0.005),EHBF(P=0.014),Meld+ICGR_(15)Score(P<0.001),死亡组肝脏血流量低于存活组,其他指标死亡组均显著高于存活组,差异有统计学意义。各种模型对HBV-ACLF短期预后评估的曲线下面积(AUC)的比较:MELD+ICGR_(15) Score(AUC:0.877),MELD(AUC:0.851),CTP(AUC:0.638),ICGR_(15)(AUC:0.551),EHBF(AUC:0.378),MELD+ICGR_(15)Score的ROC曲线下面积明显大于其他单一模型的ROC曲线下面积。【结论】MELD评分联合ICGR15Score对于HBV相关ACLF短期预后的预测敏感性和特异性优于MELD评分以及其他模型。

【Objective】To assess the value of the model for end-stage liver disease(MELD)score combining with indocyanine green clearance test(ICG)on the short-term prognosis in the patients with HBV-associated acute-on-chronic liver failure(ACLF).【Methods】A retrospective analysis was performed on 138 HBV-associated ACLF patients who were hospitalized in the Department of Infectious Diseases of the Third Affiliated Hospital of Sun Yat-sen University from June 2017 to December 2017.ICG was performed within 24 hours of clinical diagnosis of HBV-associated ACLF.The indocyanine green clearance retention at 15 min(ICGR15),the effective hepatic blood flow(EHBF)value and clinical indicators in 24 hours were recorded.After establishing the ICG R15 conversion model(ICGR15 Score),the 28-day survival rate of the enrolled patients were predicted by ICGR15 score combined MELD score,MELD score,ICGR15,EHBF and Child-Pugh score.The sensitivity and specificity of each scoring system to predict prognosis of HBV associated ACLF were compared according to the area under the ROC curve(AUC).P<0.05 were considered statistically significant.【Results】Comparison of the survival group and the non-survival group:Non-survival group was older than the survival group(P=0.011).The clinical data showed that TBil(P<0.001),DBil(P<0.001),PT(P<0.001),PTA(P<0.001),CREA(P=0.008),ICGR15 Score(P=0.002),MELD score(P<0.001),CTP grade(P=0.005),EHBF(P=0.014),MELD+ICGR15 score(P<0.001).The non-survival group had a lower liver blood flow than the survival group while the other clinical indicators were significantly higher than the survival group and the difference was statistically significant.Comparison of the AUC of different models for HBV-ACLF prognostic evaluation:MELD+ICGR15 score(AUC:0.877),MELD(AUC:0.851),CTP(AUC:0.638),ICGR15(AUC:0.551),EHBF(AUC:0.378).The AUC of MELD+ICGR15 score is significantly larger than other single models.【Conclusion】MELD+ICGR15 score has higher sensitivity and specificity in predicting the short-term prognosis of HBV-related ACLF than other single models.