基于COSSH-ACLFs模型和MELD模型回顾性调查解毒化瘀颗粒对ACLF患者预后的影响

The effect of Jiedu Huayu granules on the prognosis of ACLF patients was retrospectively investigated based on COsSH-ACLFS model and MELD model

目的:探讨COSSH-ACLF模型和终末期肝病模型(MELD)对接受常规西医治疗并服用解毒化瘀颗粒的HBV-ACLF患者的预后评价影响。方法:回顾分析2015年1月至2020年12月在广西中医药大学第一附属医院肝病科收治入院的196例HBV-ACLF患者临床资料,入院后记录所有患者的年龄、性别、外周血WBC、RBC、Hb、Plt、ALT、AST、Alb、TBil、肌酐(Cr)、PT、国际标准化比值(INR)、PTA、血氧饱和度(SPO_(2))及吸氧流量(FiO_(2))、平均动脉压;收集患者相关并发症,包括上消化道出血、肝性脑病(HE)、腹膜炎。采用受试者工作特征曲线(ROC)和曲线下面积(AUC)比较2种评分模型对HBV-ACLF患者短期预后的预测能力,同时根据ROC的特异度和敏感度取每个评分预测死亡危险性的最佳临界值。结果:中药组患者外周血ALT、TBil水平较西药组明显降低(P<0.05);死亡组患者外周血WBC、TBil、PT、INR明显高于生存组(P<0.001),PTA、Hb、Alb明显低于生存组(P<0.05)。死亡组患者并发症肝性脑病、腹膜炎发生率高于生存组(P<0.05)。评分模型COSSH-ACLFs和MELD的AUC分别为0.818和0.797,COSSH-ACLFs的AUC大于MELD(P<0.001)。结论:COSSH-ACLFs评分模型对解毒化瘀颗粒治疗HBV-ACLF患者预后的预测价值优于MELD。

Objective:To investigate the effect of COSSH-ACLF model and MELD model on the prognosis of PATIENTS with HBV-ACLF who received conventional western medicine treatment and took Traditional Chinese medicine preparation(Jiudu Huayu granules).Methods:The clinical data of 196 hbV-ACLF patients admitted to the Department of Hepatology,The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine from January 2015 to December 2020 were retrospectively analyzed.Age,sex,WBC,RBC,Hb,PLT,ALT,AST,Alb,TBil,Creatinine(Cr),PT,INTERNATIONAL standardized ratio(INR),PTA,oxygen saturation(SPO_(2)),oxygen flow(FiO_(2))and mean arterial pressure of all patients were recorded after admission.Related complications including upper gastrointestinal bleeding,hepatic encephalopathy(HE),and peritonitis were collected.The receiver operating characteristic curve(ROC)and area under the curve(AUC)were used to compare the predictive ability of the two scoring models for the short-term prognosis of patients with HBV-ACLF.The best cut-off value of each score was determined according to the specificity and sensitivity of ROC.Results:The levels of ALT(P=0.024)and TBil(P<0.001)in peripheral blood of Chinese medicine group were significantly lower than those of Western medicine group.The WBC(P<0.001),TBil(P<0.001),PT(P<0.001)and INR(P<0.001)of peripheral blood in the death group were significantly higher than those in the survival group,while PTA(P<0.001),Hb(P=0.038)and Alb(P=0.042)were significantly lower than those in the survival group.The incidence of hepatic encephalopathy(P<0.001)and peritonitis(P=0.005)in death group was higher than that in survival group.The AUC of COsSH-ACLFS and MELD was 0.818 and 0.797,respectively.The AUC of COSSH-ACLFS was higher than that of MELD(P<0.001).Conclusion:The prognostic value of COSSH-ACLFS scoring model in treating PATIENTS with HBV-ACLF with Jiedu Huayu Granules is better than that of MELD.