MELD、AARC、COSSH评分系统对乙型肝炎相关慢加急性肝衰竭90天预后的评估价值

张文佳; 赵丽娟; 吴基洲

doi:10.3969/j.issn.1001-5256.2020.04.021

MELD、AARC、COSSH评分系统对乙型肝炎相关慢加急性肝衰竭90天预后的评估价值

DOI: 10.3969/j.issn.1001-5256.2020.04.021

1. 锦州医科大学研究生院
2. 锦州医科大学附属第三医院消化科
3. 朝阳市中心医院消化科

详细信息

中图分类号: R575.3;R512.62
计量
- 文章访问数: 1523
- HTML全文浏览量: 60
- PDF下载量: 209
- 被引次数: 0
出版历程
- 收稿日期: 2019-10-11
- 出版日期: 2020-04-20

Value of MELD、AARC、COSSH ccoring systems in evaluating the 90-day prognosis of hepatitis B virus-related acute-on-chronic liver failure

Graduate School,Jinzhou Medical University

摘要

摘要: 目的评估MELD、AARC、COSSH三种评分系统对乙型肝炎相关慢加急性肝衰竭（HBV-ACLF）患者90 d预后的预测价值。方法收集2017年7月-2019年5月在朝阳市中心医院住院治疗的88例HBV-ACLF患者的临床资料,根据入院后90 d随访结果分为生存组（n=35）和死亡组（n=53）;对影响HBV-ACLF患者90 d预后的相关因素进行分析,并计算三种评分系统得分,评估三种评分系统的预测价值。符合正态分布的计量资料两组间比较采用t检验,非正态分布的计量资料两组间比较采用MannWhitney U检验,计数资料两组间比较采用χ2检验;采用多因素二元logistic回归分析影响HBV-ACLF预后的因素;绘制受试者工作特征曲线（ROC曲线）,三组评分的ROC曲线下面积（AUC）两两比较采用Z检验。结果单因素分析结果显示:年龄、TBil、WBC、PLT、尿酸（SUA）、肌酐（Cr）、凝血酶原活度（PTA）、血清钠离子浓度（Na）、国际标准化比值（INR）、动脉血乳酸（Lac）、氧合指数（PaO2/FiO2）、并发症...
- 肝功能衰竭 /
- 预后 /
- 危险因素
Abstract: Objective To investigate the value of Model for End-Stage Liver Disease( MELD),APASL-ACLF Research Consortium( AARC),and Chinese Group on the Study of Severe Hepatitis B( COSSH) scoring systems in evaluating the 90-day prognosis of hepatitis B virus-related acute-on-chronic liver failure( HBV-ACLF). Methods A retrospective analysis was performed for the clinical data of88 patients with HBV-ACLF who were hospitalized in Chaoyang Central Hospital from July 2017 to May 2019,and according to the follow-up results on day 90 after admission,the patients were divided into survival group with 35 patients and death group with 53 patients. The influencing factors for the 90-day prognosis of HBV-ACLF patients were analyzed; the above three scores were determined,and their predictive value was evaluated. The t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. A multivariate binary logistic regression analysis was used to investigate the influencing factors for the prognosis of HBV-ACLF. The receiver operating characteristic( ROC) curve was plotted,and the Z test was used for comparison of area under the ROC curve( AUC) between two scores. Results The univariate analysis showed that there were significant differences between the two groups in age,total bilirubin( TBil),white blood cell count,platelet count,uric acid,creatinine( Cr),prothrombin activity,serum sodium concentration( Na),international standardized ratio,arterial blood lactate,oxygenation index( PaO2/FiO2),complications( hepatic encephalopathy,pulmonary infection,upper gastrointestinal bleeding,and hepatorenal syndrome),MELD score,AARC score,and COSSH score( all P < 0. 05). The multivariate logistic regression analysis found that TBil( odds ratio [OR]= 0. 982,95%confidence interval [CI]: 0. 970-0. 995,P = 0. 006),Na( OR = 1. 168,95% CI: 1. 024-1. 332,P = 0. 021),Cr( OR = 0. 950,95%CI: 0. 906-0. 996,P = 0. 033),age( OR = 0. 910,95% CI: 0. 842-0. 983,P = 0. 016),and PaO2/FiO2( OR = 1. 058,95% CI: 1. 028-1. 089,P < 0. 001) were independent influencing factors for the 90-day prognosis of patients with HBV-ACLF. The ROC curve analysis showed that COSSH score had significantly higher AUC and Youden index than MELD score( 0. 937/0. 820 vs 0. 836/0. 574) and AARC score( 0. 937/0. 820 vs 0. 816/0. 497),and COSSH score had a significantly higher AUC than AARC score( Z = 3. 082,P < 0. 05).Conclusion These three scoring systems have a good value in evaluating the 90-day prognosis of HBV-ACLF patients,and COSSH score may have a higher value than the other two scores.
- liver failure /
- prognosis /
- risk factors

HTML全文

参考文献(20)

[1] Liver Failure and Artificial Liver Group,Chinese Society of Infectious Diseases,Chinese Medical Association; Severe Liver Disease and Artificial Liver Group,Chinese Society of Hepatology,Chinese Medical Association. Guideline for diagnosis and treatment of liver failure(2018)[J]. J Clin Hepatol,2019,35(1):38-44.(in Chinese)中华医学会感染病学分会肝衰竭与人工肝学组，中华医学会肝病学分会重型肝病与人工肝学组．肝衰竭诊治指南(2018年版)[J]．临床肝胆病杂志，2019,35(1):38-44.

[2] ZHOU XQ. New techniques for the treatment of severe hepatitis[M]. Beijing:Wilitary Science Publishing House,2002:21.(in Chinese)周霞秋．重型肝炎治疗新技术[M]．北京:人民军医出版社，2002:21.

[3] TIAN YQ,ZHOU N,JIANG YF. Curative efficacy of granulocyte colony-stimulating factor in combination with entecavir in patients with hepatitis B virus related acute-on-chronic liver failure at early stage and its influences on levels of AngⅡ，TNF-α，and IL-10[J]. China Med Herald,2018,15(17):139-142.(in Chinese)田玉球，周宁，蒋永芳．粒细胞集落刺激因子联合恩替卡韦治疗早期乙肝慢加急性肝衰竭的效果及对AngⅡ、TNF-α和IL-10的影响[J]．中国医药导报，2018,15(17):139-142.

[4] Chinese Society of Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B:A 2015 update[J]. J Clin Hepatol,2015,31(12):1941-1960.(in Chinese)中华医学会肝病学分会，中华医学会感染病学分会．慢性乙型肝炎防治指南(2015年更新版)[J]．临床肝胆病杂志，2015,31(12):1941-1960.

[5] Chinese Society of Hepatology,Chinese Medical Association.Guidelines on the management of hepatic encephalopathy in cirrhosis[J]. J Clin Hepatol,2018,34(10):2076-2089.(in Chinese)中华医学会肝病分学会．肝硬化肝性脑病诊疗指南[J]．临床肝胆病杂志，2018,34(10):2076-2089.

[6] KAMATH PS,WIESNER RH,MALINCHOC M,et al. A model to predict survival in patients with end-stage liver disease[J]. Hepatology,2001,33(2):464-470.

[7] WU TZ,LI J,SHAO L,et al. Development of diagnostic criteria and a prognostic score for hepatitis B virus-related acute-onchronic liver failure[J]. Gut,2018,67(12):2181-2191.

[8] SARIN SK,KEDARISETTY CK,ABBAS Z,et al. Acute-onchronic liver failure:Consensus recommendations of the Asian Pacific Association for the Study of the Liver(APASL)2014[J]. Hepatol Int,2014,8(4):453-471.

[9] LIU J,BAI FY,ZHANG J. Research advances in diagnostic criteria for acute-on-chronic liver failure and models for prognostic evaluation[J]. J Clin Hepatol,2019,35(6):1384-1387.(in Chinese)刘娟，白飞云，张晶．慢加急性肝衰竭的诊断标准比较及预后判断模型进展[J]．临床肝胆病杂志，2019,35(6):1384-1387.

[10] CHEN W,YOU J,CHEN J,et al. Modified model for endstage liver disease improves short-term prognosis of hepatitis B virus-related acute-on-chronic liver failure[J]. World J Gastroenterol,2017,23(40):7303-7309.

[11] ANGELI P,WONG F,WATSON H,et al. Hyponatremia in cirrhosis:Results of a patient population survey[J]. Hepatology,2006,44(6):1535-1542.

[12] WANG X,WANG L. Clinical analysis of elderly hyponatremia[J]. Chin J Geriatr,2017,36(4):447-449.(in Chinese)王霞，王翎．老年人低钠血症临床分析[J]．中华老年医学杂志，2017,36(4):447-449.

[13] NI XZ,WU ZY,CHEN ZP,et al. Expression of ET-1 mRNA in the lung of hepatopulmonary syndrome rats[J]. Chin J Surg,2002,40(2):142-145.(in Chinese)倪醒之，吴志勇，陈治平，等．内皮素-1 mRNA在肝肺综合征大鼠肺组织中表达的研究[J]．中华外科杂志，2002,40(2):142-145.

[14] ZHANG JL,YANG WL,HU BQ,et al. Endothelin-1 activation of the endothelin B receptor modulates pulmonary endothelial CX3CL1 and contributes to pulmonary angiogenesis in experimental hepatopulmonary syndrome[J]. Am J Pathol,2014,184(6):1706-1714.

[15] TONG JJ,ZHAO W,MU XY,et al. Predictive value of the Chinese group on the study of severe hepatitis B-acute-on-chronic liver failure score in the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure[J].Chin Med J(Engl),2019,132(13):1541-1549.

[16] MALINCHOC M,KAMATH P S,GORDON F D,et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts[J]. Hepatology,2000,31(4):864-871.

[17] CAI XJ,SHEN J,ZHU XH,et al. Evaluation of integrated model for end-stage liver disease model in predicting prognosis of acute-on-chronic liver failure and the choice of treatment[J/CD]. Chin J Exp Clin Infect Dis(Electronic Edition),2018,12(5):446-452.(in Chinese)蔡晓娟，沈毅，朱晓红，等．整合终末期肝病模型在慢加急性肝功能衰竭预后判断及治疗中的应用[J/CD]．中华实验和临床感染病杂志(电子版)，2018,12(5):446-452.

[18] GYORI GP,SILBERHUMER GR,RAHMEL A,et al. Impact of dynamic changes in MELD score on survival after liver transplantation-a Eurotransplant registry analysis[J]. Liver Int,2016,36(7):1011-1017.

[19] European Association for the Study of the Liver. EASL clinical practice guidelines:Liver transplantation[J]. J Hepatol,2016,64(2):433-485.

[20] ZHANG DJ,ZHOU B,HOU JL. Research progress in prognostic models of acute-on-chronic liver failure[J]. J Clin Hepatol,2018,34(6):1351-1356．张东敬，周彬，侯金林．慢加急性肝衰竭预后模型的研究进展[J]．临床肝胆病杂志，2018,34(6):1351-1356.

施引文献

资源附件(0)

访问统计