乙型肝炎病毒相关慢加急性肝衰竭的MELD评分变化及意义

Changes and significance of MELD score in hepatitis B virus associated acute-on-chronic liver failure

目的研究乙型肝炎病毒相关慢加急性肝衰竭(hepatitis B virus associated acute-on-chronic liver failure,HBV-ACLF)患者终末期肝病模型(model for end-stage liver disease,MELD)评分变化及其与预后的相关性。方法回顾性分析2019年1月至2021年12月于杭州市西溪医院接受治疗的74例HBV-ACLF患者的临床资料,根据预后将患者分为存活组(n=41)和死亡组(n=33)。比较两组患者的MELD评分及甲胎蛋白(alpha fetoprotein,AFP)、胆碱酯酶(choline esterase,CHE)、乳酸(lactic acid,Lac)水平,采用Logistic回归分析探讨HBV-ACLF患者预后的影响因素,绘制受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)评估MELD评分、AFP、CHE、Lac对HBV-ACLF患者预后的价值。结果存活组患者的MELD评分、Lac水平均显著低于死亡组,AFP、CHE水平均显著高于死亡组(P<0.05);Logistic回归分析结果显示,MELD评分增加、AFP水平降低、CHE水平降低、Lac水平升高均为HBV-ACLF患者死亡的独立危险因素(P<0.05);ROC曲线结果显示,MELD评分、AFP、CHE、Lac均可有效预测HBV-ACLF患者的预后情况,曲线下面积分别为0.805、0.989、0.729、0.753。结论HBV-ACLF死亡患者的MELD评分、Lac水平升高,AFP、CHE水平降低,MELD评分、AFP、CHE、Lac均为影响HBV-ACLF患者预后的重要因素,可作为预后转归评估的参考依据。

Objective To study the correlation between the score of model for end-stage liver disease(MELD)score and prognosis in patients with hepatitis B virus associated acute-on-chronic liver failure(HBV-ACLF).Methods The clinical data of 74 patients with HBV-ACLF who were treated in Hangzhou Xixi hospital from January 2019 to December 2021 were retrospectively analyzed and the patients divided into survival group(n=41)and death group(n=33)based on the prognosis.The MELD score and the levels of alpha fetoprotein(AFP),choline esterase(CHE),and lactic acid(Lac)were compared between the two groups.Logistic regression analysis was used to explore the factors influencing the prognosis of patients with HBV-ACLF,and the receiver operator characteristic(ROC)curve was drawn to evaluate the prognostic value of MELD score,AFP,CHE and Lac in patients with HBV-ACLF.Results MELD score and Lac level in survival group were significantly lower than those in death group,AFP and CHE levels were significantly higher than those in death group(P<0.05).Logistic regression analysis showed that increased MELD score,decreased AFP level,decreased CHE level and increased Lac level were independent risk factors for death in patients with HBV-ACLF(P<0.05).ROC curve results showed that MELD score,AFP,CHE and Lac could effectively predict the prognosis of HBV-ACLF patients,and the areas under the curve were 0.805,0.989,0.729 and 0.753,respectively.Conclusion MELD score and Lac level were increased in patients with HBV-ACLF death,while AFP and CHE levels were decreased.MELD score,AFP,CHE and Lac are all important factors affecting the prognosis of patients with HBV-ACLF,and can be used as a reference for prognosis evaluation.