PTAR联合Child-Pugh及MELD评分对肝硬化患者发生慢加急性肝衰竭预测价值研究

Clinical significance of PTAR,Child-Pugh and MELD score in predicting the occurence of acute-on-chronic liver failure in patients with cirrhosis

目的探讨影响乙肝肝硬化及酒精性肝硬化患者发生慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)的危险因素,并建立新的评分模型预测ACLF的发生。方法纳入乙肝肝硬化患者148例,酒精性肝硬化患者113例。根据6个月内随访记录,将进展为ACLF者纳入ACLF组(24例),未进展为ACLF者纳入非ACLF组(237例)。收集患者临床资料,并计算凝血酶原国际标准化比值与血清白蛋白比值(PTAR)等评分。分析影响ACLF进展的独立危险因素后建立新的预测模型,并通过建立受试者工作特征曲线(ROC)评价新型模型对ACLF发生的预测价值。结果Child-Pugh及PTAR评分是影响乙肝肝硬化患者发展为ACLF的独立危险因素。PTAR及MELD评分是影响酒精性肝硬化患者发展为ACLF的独立危险因素。乙肝肝硬化中Child-Pugh、PTAR、PTAR-CP的曲线下面积(AUC)分别为0.691、0.755、0.805,PTAR-CP≥-3.93患者发生ACLF的风险高。酒精性肝硬化中MELD、PTAR、PTAR-MELD的AUC分别为0.715、0.744、0.773,PTAR-MELD≥-2.15患者发生ACLF的风险高。结论PTAR-CP对乙肝肝硬化进展为ACLF的预测价值更高,而PTAR-MELD对酒精性肝硬化进展为ACLF的预测价值更高。ABIC、ALBI对于肝硬化患者进展为ACLF的预测价值有限。

Objective To investigate the risk factors affecting the occurence of acute-on-chronic liver failure(ACLF)in patients with hepatitis B cirrhosis and alcoholic cirrhosis,and establish a new scoring model to predict the occurrence of ACLF.Methods 148 cases with hepatitis B cirrhosis and 113 cases with alcoholic cirrhosis were enrolled.According to the follow-up records within 6 months,they were divided into ACLF group(n=24)and non-ACLF group(n=237)according to whether they progress into ACLF.Clinical data of the first admission were collected,and the PTAR,ALBI,ABIC,Child-Pugh,MELD,MELD-Na scores were calculated.Multivariate Logistic regression analysis was used to analyze the independent risk factors affecting the development of ACLF,and a new prediction model was established.Area under the receiver operating characteristic curve was used to calculate the predicted value of the models with respect to the occurence of ACLF.Results In hepatitis B cirrhosis,Child-Pugh and PTAR scores were independent risk factors affecting the development of ACLF.PTAR and MELD scores were independent risk factors in alcoholic cirrhosis.In hepatitis B cirrhosis,the AUC of Child-Pugh,PTAR and PTAR-CP were 0.691,0.755 and 0.805,respectively.Patients with PTAR-CP≥-3.93 had a higher risk of ACLF than patients<-3.93.In alcoholic cirrhosis,the AUC of MELD,PTAR and PTAR-MELD was 0.715,0.744 and 0.773,respectively.Patients with PTAR-MELD≥-2.15 had a higher risk of ACLF than those<2.15.Conclusion PTAR-CP can predict the occurrence of ACLF in patients with hepatitis B cirrhosis more accurately.While the predictive value of PTAR-MELD is higher in alcoholic cirrhosis.ABIC and ALBI scores are of limited value in predicting the progression of ACLF in patients with cirrhosis.