摘要
目的 通过分析肝硬化患者终末期肝病模型(MELD)评分和吲哚菁绿清除试验(ICG_(R15))评分的关系,并就ICG_(R15)、MELD和MELD-ICG_(R15)评分对患者在半年内及远期是否发生并发症的预测效能进行比较,为肝硬化患者的并发症预防及治疗时机选择提供临床依据。方法 选取2017年4月至2018年4月因肝硬化入院深圳市人民医院感染内科的患者112例。观察入组患者6个月、1年、2年、3年内发生并发症的情况,统计并分析肝硬化患者MELD、MELD-ICG_(R15)评分分值与发生并发症的关系。使用灵敏度、特异度和受试者工作特征曲线(ROC曲线)的曲线下面积(AUC)进行评估,评价ICG_(R15)、MELD、MELD-ICG_(R15)评分对于肝硬化患者出现并发症可能性预测价值(P <0.05)。结果 入组患者在6个月、1年、2年、3年的并发症发生率分别为48.2%(54/112)、50.0%(56/112)、50.9%(57/112)、50.9%(57/112)。有并发症患者和无并发症患者两组间年龄(t=-0.929,P=0.357)、性别(χ^(2)=0.429,P=0.521)、血清肌酐值(Scr)(t=-1.229,P=0.224)和国际标准化比值(INR)(t=-1.825,P=0.069)差异无统计学意义(P>0.05);血清总胆红素(TBil)(t=-2.869,P=0.006)、血清白蛋白(ALB)(t=4.998,P <0.001)、ICG_(R15)(t=-5.264,P <0.001)、MELD评分(t=-4.678,P <0.001)、MELD-ICG_(R15)评分(t=-6.041,P <0.001)有统计学差异(P<0.05)。MELD-ICG_(R15)评分的AUC为0.866,95%CI为0.799~0.933,cut-off值为47.5,对应的灵敏度为0.870,特异度为0.759。纳入观察的指标中,MELD-ICG_(R15)评分的AUC最大,优于ICG_(R15)(AUC:0.824)、MELD评分(AUC:0.830)。结论 ICG_(R15)、MELD评分、MELD-ICG_(R15)评分可对于肝硬化患者6个月内及远期出现并发症进行预测,其中MELD-ICG_(R15)评分预测效能最佳。
Objective To analyze the relationship between MELD score and ICGR15 score in patients with liver cirrhosis,and to compare the predictive efficacy of complications about ICGR15,MELD and MELD-ICGR15 score in patients with liver cirrhosis within six months and forward,so as to provide clinical basis for the choice of prevention and treatment timing of complications.Method A total of 112 patients admitted to the Department of Infectious Diseases,Shenzhen People's Hospital from April 2017 to April 2018 were enrolled.The ICGR15,MELD and MELD-ICGR15 scores of each patient were calculated.Complications within a period of time(six months,one year,two years,three years respectively)were observed.The relationship between ICGR15,MELD,MELD-ICGR15 score and complications was analyzed,to evaluate the predictive value of ICGR15,MELD and MELD-ICGR15 scores for complications in patients with cirrhosis.Sensitivity,specificity,and area under the receiver operating characteristic(ROC)curve(AUC)were used.Result The complication rate of were 48.2%(54/112)、50.0%(56/112)、50.9%(57/112)、50.9%(57/112)during six month,one year,two years,three years respectively.There was no statistically significant difference in age(t=-0.929,P=0.357),sex(χ^(2)=0.429,P=0.521),serum creatinine(Cr)(t=-1.229,P=0.224)and INR(t=-1.825,P=0.069)between the group with and without complication.There have statistically significant differences in total bilirubin(TBil)(t=-2.869,P=0.006),serum albumin(ALB)(t=4.998,P<0.001),ICGR15(t=-5.264,P<0.001),MELD score(t=-4.678,P<0.001)and MELD-ICGR15 score(t=-6.041,P<0.001)between the two groups(P<0.05).The area under the ROC curve(AUC)of the MELD-ICGR15 score was 0.866,the 95%confidence interval was 0.799 to 0.933,the cut-off value was 47.5,the corresponding sensitivity was 0.870,and the specificity was 0.759.Incorporated in the observations among the metrics,the ROC curve of the MELD-ICGR15 score was the largest area,better than the ICGR15(AUC:0.824),MELD Score(AUC:0.830),the area under the ROC curve of the MELD-ICGR15 score was the largest,better than the ICGR15(AUC:0.824)and MELD score(AUC:0.830).Conclusion The ICGR15,MELD score and MELD-ICGR15 score can predict the complications in patients with cirrhosis within 6 months and forward,but the MELD-ICGR15 score is the best.
作者
杨智
吴伟刚
欧鹏程
陈洪涛
曾芙蓉
解东媛
杨林
杨桂林
Yang Zhi;Wu Weigang;Ou Pengcheng;Chen Hongtao;Zeng Furong;Xie Dongyuan;Yang Lin;Yang Guilin(Department of Infectious Medicine Diseases,Shenzhen People's Hospital,Guangdong Shenzhen 518020,China)
出处
《新发传染病电子杂志》
2023年第3期19-24,共6页
Electronic Journal of Emerging Infectious Diseases
基金
广东省基础与应用基础研究基金深圳市联合基金(粤深联合基金)项目(2021B151510058)。
关键词
肝硬化
并发症
吲哚菁绿清除试验
终末期肝病模型评分
Cirrhosis of the liver
Complication
Indocyanine green clearance test
Model for end stage liver disease score