终末期肝病模型、Child-Pugh分级对HBV感染肝硬化失代偿期患者疾病转归的影响

Effects of model for end-stage liver disease and Child-Pugh grade on the disease outcome of patients with HBV-infected liver cirrhosis in the decompensated stage

目的分析终末期肝病模型、Child-Pugh分级对乙肝病毒(HBV)感染肝硬化失代偿期患者疾病转归的影响。方法选择本院2019年1月至2021年12月收治的HBV感染肝硬化失代偿期患者106例,随访6个月统计疾病转归状况,并统计终末期肝病模型(Model for end-stage liver disease,MELD)评分、Child-Pugh分级对于疾病转归的诊断效能。结果随访6个月,106例HBV感染肝硬化失代偿期患者死亡率为38.68%(41/106),存活率为61.32%(65/106);存活者MELD评分、Child-Pugh分级分值少于死亡者(P<0.05);随MELD评分和Child-Pugh分级增加,死亡率逐渐升高(P<0.05);以死亡患者作为阳性样本,存活患者作为阴性样本,结合MELD评分、Child-Pugh分级评分变化趋势制作ROC曲线,MELD评分联合Child-Pugh分级诊断的AUC是0.771、敏感性92.68%、特异性92.31%;MELD评分的AUC是0.646、敏感性65.85%、特异性70.77%;Child-Pugh分级的AUC是0.726、敏感性60.97%、特异性73.85%,其中联合诊断敏感性、特异性最高(P<0.05)。结论HBV感染肝硬化失代偿期患者不同MELD评分、Child-Pugh分级预后不同,MELD评分、Child-Pugh分级联合评估预后具有较高敏感性与特异性。

Objective To analyze the effects of the model for end-stage liver disease(MELD)and Child-Pugh grade on the disease outcome of patients with hepatitis B virus(HBV)infection and decompensated stage of liver cirrhosis.Methods A total of 106 patients with HBV-infected liver cirrhosis in the decompensated stage.who were admitted to our hospital from January 2019 to December 2021 were selected as the research objects.The patients were followed-up for 6 months to calculate the disease outcome and analyze the diagnostic efficacy for disease outcome of MELD and Child-Pugh grade.Results Followed up for 6 months,106 patients with HBV infection and decompensated cirrhosis had a mortality rate of 38.68%(41/106)and a survival rate of 61.32%(65/106).The survivors′MELD score and Child-Pugh gradewere less than those of the dead(P<0.05).As the MELD scoreand the Child-Pugh grade increased,the mortality rate gradually increased(P<0.05).The ROC curves of MELD score and Child-Pugh grade were made by taking the dead patients as positive samples and taking the survived patients as negative samples.The results showed that the AUC of MELD score combined with Child-Pugh grade is 0.771,the sensitivity is 92.68%,and the specificity is 92.31%.The AUC of the MELD score is 0.646,the sensitivity is 65.85%,and the specificity is 70.77%.The AUC of Child-Pugh grade was 0.726,the sensitivity was 60.97%,and the specificity was 73.85%.The combined diagnosis had the highest sensitivity and specificity(P<0.05).Conclusion Different MELD scores and Child-Pugh grades have different prognosis in patients with HBV-infected liver cirrhosis in the decompensated stage.The combined evaluation of the prognosis by MELD scores and Child-Pugh grades has high sensitivity and specificity.