终末期肝病模型和吲哚菁绿清除试验联合评分对肝硬化患者并发症发生的预测价值

Predictive value of MELD-ICG_(R15) score for complications in patients with liver cirrhosis

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.