血清神经元特异性烯醇化酶等指标预测肝硬化合并显性肝性脑病患者预后的价值

Value of indicators including serum neuron-specific enolase in assessing prognosis of patients with cirrhosis complicated by overt hepatic encephalopathy

目的 探讨血清神经元特异性烯醇化酶(NSE)、预后营养指数(PNI)评分、肝性脑病(HE)分级、Integrated终末期肝病模型(iMELD)评分模型预测肝硬化合并显性HE患者近期(90 d)预后的价值。方法 回顾性分析470例肝硬化合并显性HE患者的临床资料,根据患者入院后90 d生存状态将患者分为存活组359例和死亡组111例。结合患者年龄、入院后24 h内血常规、凝血功能、肝肾功能电解质、血清NSE水平、HE分级,计算PNI评分、iMELD评分。采用受试者工作特征(ROC)曲线、多因素Logistic回归分析及Kaplan-Meier生存曲线评估影响肝硬化合并显性HE患者近期预后的因素。结果 死亡组血清NSE、HE分级、iMELD评分高于存活组,PNI评分低于存活组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果提示,肝硬化合并显性HE患者近期预后的独立影响因素为血清NSE、PNI评分、HE分级、iMELD评分。血清NSE、PNI评分、HE分级、iMELD评分预测肝硬化合并显性HE患者近期预后的曲线下面积(AUC)分别为0.727、0.717、0.721、0.728;血清NSE、PNI评分、iMELD评分的cut-off值分别为12.23 ng/mL、34.05 ng/mL、39.26分;四者联合预测模型的预测效能最佳,AUC达到0.919,cut-off值为0.23。Kaplan-Meier生存分析提示,血清NSE、PNI评分、HE分级和iMELD评分联合预测模型cut-off值<0.23的患者90 d生存率高于血清NSE、PNI评分、HE分级和iMELD评分联合预测模型cut-off值≥0.23的患者(Log-Rank=265.567,P<0.001)。结论 血清NSE、PNI评分、HE分级、iMELD评分对预测肝硬化合并显性HE患者的近期预后具有良好的价值,联合应用预测价值更高。

Objective To investigate the predictive value of serum neuron-specific enolase(NSE),prognostic nutritional index(PNI) score,hepatic encephalopathy(HE) grading,and the integrated model for end-stage liver disease(iMELD) score in assessing the short-term(90-day)prognosis of patients with cirrhosis complicated by overt hepatic encephalopathy(HE).Methods A retrospective analysis was conducted on clinical data from 470 patients with cirrhosis and overt HE,and they were divided into survival group(n=359) and mortality group(n=111) based on their survival status 90 days after admission.The PNI and iMELD scores were calculated using patient demographics,blood routine tests,coagulation function,liver and renal function electrolyte levels,and serum NSE levels within 24 hours of admission,along with HE grading.Receiver operating characteristic(ROC) curves,multivariate Logistic regression analysis,and Kaplan-Meier survival curves were employed to evaluate influencing factors of short-term prognosis of patients with cirrhosis and overt HE.Results The mortality group exhibited significantly higher serum NSE levels,HE grades,and iMELD scores,while demonstrated lower PNI score compared to the survival group(P <0.05).Multivariate Logistic regression analysis identified serum NSE,PNI score,HE grade,and iMELD score as independent predictors of short-term prognosis.The areas under the curve(AUCs) for serum NSE,PNI score,HE grade,and iMELD score in predicting short-term prognosis were 0.727,0.717,0.721,and 0.728,respectively,with cut-off values of 12.23 ng/mL,34.05 ng/mL,and 39.26points for serum NSE,PNI score,and iMELD score.A combined prediction model of four factors demonstrated the highest predictive performance,with an AUC of 0.919 and a cut-off value of 0.23.Kaplan-Meier survival analysis revealed that patients with combined score of serum NSE,PNI score,HE grade,and iMELD cut-off value <0.23 had a significantly higher 90-day survival rate compared to those with cut-off value ≥0.23(Log-Rank=265.567,P <0.001).Conclusion Serum NSE,PNI score,HE grade,and iMELD score exhibit good value in predicting the short-term prognosis of patients with cirrhosis and overt HE,with an even higher predictive value when used in combination.