MELD联合血小板体积对HBV相关亚急性肝衰竭预后预测作用

The predictive effect of MELD combined with platelet volume on the prognosis of patients with HBV-related acute-on-chronic liver failure

目的探讨终末期肝病模型(model for end-stage liver disease,MELD)评分联合平均血小板体积(mean platelet volume,MPV)预测乙型肝炎病毒相关亚急性肝衰竭(hepatitis B virus related acute-on-chronic liver failure,HBV-ACLF)患者短期预后的临床价值.方法回顾性收集并分析2015年1月—2020年12月我院诊治的298例HBV-ACLF患者的临床资料.根据患者3个月生存状况分为好转组152例、未好转组146例.通过电子病历系统收集两组入院时临床资料,多因素logistic回归分析HBV-ACLF患者预后的影响因素,并采用ROC曲线对预测效能进行评定.结果未好转组年龄>55岁、糖尿病、肝性脑病比率以及MPV、MELD评分等均高于好转组,血小板低于好转组,(P<0.05),两组性别比例、高血压等均无统计学差异(P>0.05).多因素logistic回归分析结果显示,年龄>55岁(0R=1.34,95%CI:1.15~1.83,P=0.036)、肝性脑病(OR=1.63,95%CI:1.24~3.76,P=0.015)、MPV(OR=1.46,95%CI:1.05~2.58,P=0.025)、MELD(OR=1.56,95%CI:1.19~3.37,P=0.009)是HBV-ACLF患者3个月未好转的危险因素.ROC曲线分析显示,MELD+MPV联合预测HBV-ACLF患者未好转的AUC为0.866(95%CI:0.812~0.921),高于MPV、MELD单独预测的AUC[0.710(95%CI:0.631~0.789)、0.746(95%CI:0.668~0.824)].结论MELD、MPV升高是HBV-ACLF患者短期是否好转的独立危险因素,二者联合预测的价值较高.

Objective To investigate the model for end-stage liver disease(MELD)score combined with mean platelet volume(MPV)to predict hepatitis B virus related acute-on-chronic liver failure(HBV-ACLF).Methods The clinical data of 298 HBV-ACLF patients diagnosed and treated in our hospital from January 2015 to December 2020 were retrospectively collected and analyzed.According to the 3-month survival status of patients,they were divided into 152 cases in the improvement group and 146 cases in the non-improvement group.The clinical data of the two groups at admission were collected through the electronic medical record system,and the factors affecting the prognosis of HBV-ACLF patients were analyzed by multivariate logistic regression,and the ROC curve was used to evaluate the predictive efficacy.Results The age of the unimproved group was more than 55 years old,the rates of diabetes,hepatic encephalopathy,MPV,and MELD scores were higher than those of the improved group,and platelets were lower than the improved group(P<0.05).There was no gender ratio or hypertension in the two groups.Statistical difference(P>0.05).Multivariate logistic regression analysis showed that age>55 years old(OR=1.34,95%CI:1.15-1.83,P=0.036),hepatic encephalopathy(OR=1.63,95%CI:1.24-3.76,P=0.015),MPV(OR=1.46,95%CI:1.05-2.58,P=0.025),MELD(OR=1.56,95%CI:1.19-3.37,P=0.009)are the risks of HBV-ACLF patients not getting better for 3 months factor.ROC curve analysis showed that the AUC predicted by MELD+MPV combined with HBV-ACLF patients was 0.866(95%Cl:0.812-0.921),which was higher than the AUC predicted by MPV and MELD alone[0.710(95%CI:0.631-0.789),0.746(95%CI:0.668-0.824)].Conclusion Elevated MELD and MPV are independent risk factors for short-term improvement in patients with HBV-ACLF,and the combination of the two has a higher value for prediction.