MELD、CTP评分及MLR联合预测人工肝治疗慢加急性肝衰竭预后的临床研究

Clinical study on combination of MELD,CTP score and MLR in predicting the prognosis of acute-on-chronic liver failure patients treated with artificial liver

目的利用终末期肝病模型(MELD)、肝功能Child-Turotte-Pugh(CTP)评分联合单核/淋巴细胞比值(MLR)建立经人工肝治疗的乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者的预后评估模型并评估其预测效能。方法回顾性分析2019年5月至2020年12月于该院行人工肝治疗的HBV-ACLF患者101例,根据患者治疗后90 d的结局分为生存组和死亡组。通过单因素分析、二元logistic回归分析等方法分析影响HBV-ACLF患者90 d死亡的危险因素,建立预测模型并绘制受试者工作特征(ROC)曲线评估预测价值。结果101例患者入院之日起至随访的90 d,共死亡34例,存活67例,死亡率为33.7%。生存组年龄、感染率、MLR、凝血酶原时间、国际标准化比值(INR)、血清肌酐(Crea)水平、年龄-总胆红素-INR-Crea评分、MELD评分及CTP评分均明显低于死亡组(P<0.05)。二元logistic回归分析发现,高MELD、CTP评分及MLR是经人工肝治疗90 d后HBV-ACLF患者死亡的独立危险因素。建立的MELD-CTP-MLR模型ROC曲线下面积(AUC)为0.896,明显高于CTP评分和MELD评分(P<0.05)。结论高MLR、MELD及CTP评分是经人工肝治疗HBV-ACLF患者90 d死亡的独立危险因素,MELD、CTP评分联合MLR对HBV-ACLF患者经人工肝治疗90 d预后有较好的预测价值。

Objective To establish a prognostic evaluation model for the patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)treated with artificial liver by using the end-stage liver disease model(MELD),Child-Turcotte-Pugh(CTP)score combined with mononuclear/lymphocyte ratio(MLR),and to evaluate its predictive efficiency.Methods A total of 101 patients with HBV-ACLF treated by artificial liver therapy in this hospital from May 2019 to December 2020 were retrospectively analyzed.According to the outcome 90 d after treatment,the patients were divided into the survival group and death group.The univariate analysis and binary logistic regression analysis were used to analyze the risk factors affecting 90 d death in the patients with HBV-ACLF.The predictive model was established,and the receiver operating characteristic(ROC)curve was drawn to evaluate its predictive value.Results From the day of admission to 90 d of follow-up,34 cases died and 67 cases survived,with a mortality rate of 33.7%.The age,infection rate,MLR,prothrombin time,international normalized ratio(INR),serum creatinine(Crea)level,age-bilirubin-InR-Crea score,MELD and CTP scores in the survival group were significantly lower than those in the death group(P<0.05).The binary logistic regression analysis found that high MELD,CTP score and MLR were the independent risk factors for death in the patients with HBV-ACLF after 90 d artificial liver therapy.The area under the ROC curve(AUC)of the established MELD-CTP-MLR model was 0.896,which was significantly higher than that of the CTP score and MELD score(P<0.05).Conclusion High MLR,MELD and CTP scores are the independent risk factors for 90 d death in the patients with HBV-ACLF treated with artificial liver.MELD and CTP scores combined with MLR have a good predictive value for 90 d prognosis of the patients with HBV-ACLF treated with artificial liver.