RAR联合MELD评分对乙型肝炎肝硬化严重程度的评估价值

Evaluation Value of RAR Combined with MELD Score for Severity of Hepatitis B Cirrhosis

目的探讨红细胞分布宽度(red blood cell distribution width,RDW)、血清白蛋白(serum albumin,ALB)比值(red blood cell distribution width/albumin ratio,RAR)联合终末期肝硬化模型评分(with end-stage cirrhosis model score,MELD)对乙型肝炎肝硬化严重程度的评估价值。方法纳入2019年9月至于2021年11月于锦州医科大学附属第一医院消化科明确诊断为乙型肝炎肝硬化230例,依据病情严重程度分为代偿期乙肝肝硬化组82例,失代偿期乙肝肝硬化组148例,收集一般资料及实验室检查。采用Spearman相关系数分析各指标间相关性。多因素Logistic回归分析影响乙型肝炎肝硬化严重程度的危险因素。绘制受试者工作特征曲线(ROC),比较ROC曲线下面积(AUC)评价不同指标的诊断价值。结果(1)根据多因素回归分析可知:RAR、MELD评分是乙型肝炎肝硬化病情严重程度的的独立危险因素(OR=2.788,P<0.001);(2)在失代偿期乙型肝炎肝硬化的并发症中,肝性脑病、腹水、食管静脉曲张破裂出血等无统计学差异(P>0.05),表明不同并发症的严重程度间没有差异;(3)RAR、MELD评分的ROC曲线下面积AUC=0.887,AUC=0.916,RAR联合MELD评分的AUC提高至0.959。结论RAR联合MELD评分对乙型肝炎肝硬化严重程度有较高评估价值,优于单独的RAR、MELD评分。

Objective To investigate the value of red blood cell distribution width(RDW),serum albumin ratio(ALB)combined with end-stage cirrhosis model score in evaluating the severity of hepatitis B cirrhosis.Methods A total of 230 cases of hepatitis B cirrhosis diagnosed in the Department of Gastroenterology of the First Affiliated Hospital of Jinzhou Medical University from September 2019 to November 2021 were included.According to the severity of the disease,they were divided into compensated hepatitis B cirrhosis group(82 cases)and decompensated hepatitis B cirrhosis group(148 cases).General data and laboratory tests were collected.Spearman correlation coefficient was used to analyze the correlation between the indexes.Multivariate Logistic regression analysis was used to analyze the risk factors affecting the severity of hepatitis B cirrhosis.The receiver operating characteristic(ROC)curve was drawn,and the area under the ROC curve(AUC)was compared to evaluate the diagnostic value of different indicators.Results(1)According to multivariate regression analysis,RAR and MELD scores were independent risk factors for the severity of hepatitis B cirrhosis(OR=2.788,P<0.001);(2)among the complications of decompensated hepatitis B cirrhosis,there was no significant difference in hepatic encephalopathy,ascites,esophageal variceal rupture and bleeding(P>0.05),indicating that there was no difference in the severity of different complications;(3)the area under the ROC curve of RAR and MELD score was 0.887,AUC was 0.916,and the AUC of RAR combined with MELD score increased to 0.959.Conclusion RAR combined with MELD score has a high evaluation value for the severity of hepatitis B cirrhosis,which is better than RAR and MELD score alone.