人工肝治疗急(亚急)性肝衰竭合并肝性脑病的中短期预后评估

The prognosis of acute( subacute) hepatic failure with hepatic encephalopathy treated with artificial liver

目的评估人工肝治疗急(亚急)性肝衰竭合并肝性脑病患者的预后。方法收集25例进行人工肝治疗患者的临床资料,收集患者治疗前后总胆红素、白蛋白、凝血酶原活动度、血氨等指标,并计算总胆红素清除率(total bilirubin clearance rate,TBCR)、总胆红素存留率(total bilirubin actual resident ratio,TBARR)、总胆红素反弹率(total bilirubin rebound rate,TBRR)及ΔMELD评分等相关指标。结果好转组凝血酶原活动度、血氨清除率高于恶化组,而TBARR、TBRR及ΔMELD评分低于恶化组,差异有统计学意义(P<0.05),两组间的白蛋白、血氨、MELD评分差异未见统计学意义(P>0.05)。通过绘制ROC曲线,TBARR、TBRR及ΔMELD评分曲线下面积分别为0.794、0.816、0.897。结论TBARR、TBRR及ΔMELD评分对行人工肝治疗患者的预后有一定预测价值,其中以ΔMELD评分的预测价值最大。

Objective To evaluate the prognosis of patients combined with acute(subacute)hepatic failure and hepatic encephalopathy after artificial liver treatment.Methods The clinical data of 25 patients who received artificial liver treatment were collected.Parameters including total bilirubin,albumin,prothrombin activity and blood ammonia before and after treatment were collected.Total bilirubin clearance rate(TBCR),total bilirubin actual resident ratio(TBARR),total bilirubin rebound rate(TBRR)andΔMELD score were compared.Results The Prothrombin activity and ammonia clearance were higher in the improvement group,the TBARR,TBRR andΔMELD score were lower in the improvement group compared with deterioration group,the differences were statistically significant(P<0.05).There was no difference between the two groups in albumin,blood ammonia and MELD score.The AUC of TBARR、TBRR andΔMELD was 0.794、0.816、0.897.Conclusion TBARR,TBRR andΔMELD could predict the prognosis of patients with artificial liver treatment,of whichΔMELD could predict the prognosis more precisely.