不同评分系统对乙型肝炎相关性慢加急性肝衰竭风险的预测价值观察

Predictive value of different scoring systems for the risk of acute on chronic liver failure in patients with chronic hepatitis B

目的研究不同评分系统对乙型肝炎相关性慢加急性肝衰竭风险的预测价值。方法选取94例乙型肝炎相关慢加急性肝衰竭患者的临床资料,依据肝衰竭分期分为早期组、中期组、晚期组,另外选取我院同期收治的30例慢性乙型肝炎患者,设为无肝衰竭组。所有患者入院后均在治疗前行终末期肝病模型(MELD)、血清钠浓度MELD整合模型(MELD-Na)、终末期肝病模型及血钠比值(MESO)、iMELD模型评分系统(iMELD)、序贯器官肝衰竭评估模型(SOFA)评估,对比不同肝衰竭分期及无肝衰竭患者五项评分差异,另外通过ROC曲线分析五项评分预测乙型肝炎相关慢加急性肝衰竭的价值。结果五项评分对比中,晚期组>中期组>早期组>无肝衰竭组,差异显著(P>0.05)。经ROC分析,五项评分预测乙型肝炎相关慢加急性肝衰竭的曲线下面积分别为0.938、0.976、0.960、0.902、0.903,且MELD、MELD-Na、iMELD预测乙型肝炎相关慢加急性肝衰竭的敏感度(0.989、0.947、0.968)>MESO、SOFA(0.670、0.809)。结论经ROC证实MELD、MELD-Na、iMELD、MESO、SOFA评分能为乙型肝炎相关慢加急性肝衰竭的早期诊断提供帮助。

Objective To study the predictive value of different scoring systems for the risk of chronic hepatitis B patients with acute on chronic liver failure.Methods The clinical data of 94 patients with chronic hepatitis B and acute on chronic liver failure were selected and divided into the early group,the middle group and the late group according to the stages of liver failure.In addition,30 patients with severe chronic hepatitis B admitted to our hospital at the same time were selected and set as the group without liver failure.After admission,all patients were evaluated by end-stage renal disease model(MELD),serum sodium concentration MELD integrated model(MELD-Na),end-stage renal disease model and serum sodium ratio(MESO),iMELD model scoring system(iMELD),sequential organ liver failure evaluation model(SOFA)before treatment.In addition,the ROC curve was used to analyze the value of five scores in predicting chronic hepatitis B patients with acute on chronic liver failure.Results In comparison of the five scores,there was a significant difference between the late group,the middle group,the early group and the non-liver failure group(P<0.05).According to ROC analysis,the area under the curve of predicting chronic hepatitis B patients with acute on chronic liver failure was 0.938,0.976,0.960,0.902 and 0.903 respectively,and the sensitivity of MELD,MELD Na and iMELD to predict chronic hepatitis B patients with acute on chronic liver failure(0.989,0.947,0.968)was higher than that of MESO and SOFA(0.670,0.809).Conclusion ROC curve has confirmed that MELD,MELD-Na,iMELD,MESO and SOFA scores can help in the early diagnosis of chronic hepatitis B and acute on chronic liver failure.