基于MELD评分分层分析人工肝治疗对平台期肝衰竭患者短期预后的影响

兰小勤; 纪雅丽; 陈金军; 周福元; 文维群

doi:10.3969/j.issn.1001-5256.2020.09.019

基于MELD评分分层分析人工肝治疗对平台期肝衰竭患者短期预后的影响

DOI: 10.3969/j.issn.1001-5256.2020.09.019

南方医科大学南方医院感染内科

基金项目:

国家科技重大专项子课题(2018ZX10302-206-004)；

详细信息

中图分类号: R575.3
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出版历程
- 出版日期: 2020-09-20

Effect of artificial liver support therapy on the short-term prognosis of patients with liver failure in the plateau stage: A stratified analysis based on Model for End-Stage Liver Disease score

Department of Infectious Diseases, Nanfang Hospital, Southern Medical University

Research funding:

摘要

摘要:
目的对平台期肝衰竭患者进行MELD评分分层后,研究人工肝治疗对其短期（28 d及90 d内）病死率的影响。方法回顾性纳入2015年1月-2019年4月南方医科大学南方医院收治的肝衰竭患者187例,其中人工肝组73例,非人工肝组114例。按平台期不同的MELD评分分层分析2组间28 d、90 d病死率的差异,存活者的住院费用和住院日的差异,以及人工肝不良反应发生率。计量资料2组间比较采用t检验,计数资料2组间比较采用χ2检验或Fisher确切概率法。结果人工肝治疗可显著降低MELD评分30～39分[人工肝组（5.9%） vs非人工肝组（39.6%）,P<0.001]及40分[人工肝组（25.0%） vs非人工肝组（72.7%）,P <0.05]的平台期肝衰竭患者28 d病死率。人工肝治疗可降低MELD评分30～39分平台期肝衰竭患者90 d病死率[人工肝组（23.5%） vs非人工肝组（62.3%）,P <0.001]。人工肝治疗不能明显缩短存活患者的平均住院时间（p>0.05）;人工肝治疗对90 d内存活患者的住院总费用无明显影响（P> 0.05）;人...
- 肝功能衰竭 /
- 肝,人工 /
- 血浆置换 /
- 预后
Abstract:
Objective To investigate the effect of artificial liver support therapy on the short-term( 28-and 90-day) mortality rate of patients with liver failure in the plateau stage through a stratified analysis based on Model for End-Stage Liver Disease( MELD) score.Methods A retrospective analysis was performed for 187 patients with liver failure who were admitted to Nanfang Hospital,Southern Medical University,from January 2015 to April 2019,with 73 patients in the artificial liver group and 114 in the non-artificial liver group. The stratified analysis based on MELD score in the plateau stage was performed to investigate the differences in 28-and 90-day mortality rates,hospital costs and length of hospital stay of surviving patients,and incidence rate of adverse reactions of artificial liver support therapy between the two groups. The t-test was used for comparison of continuous data between the two groups,and the chi-square test or the Fisher's exact test was used for comparison of categorical data between the two groups. Results Compared with the non-artificial liver group,the artificial liver group had a significant reduction in the 28-day mortality rate of the patients with an MELD score of 30-39( 5. 9% vs39. 6%,P < 0. 001) or those with an MELD score of 40( 25. 0% vs 72. 7%,P < 0. 05). Compared with the non-artificial liver group,the artificial liver group had a significant reduction in the 90-day mortality rate of the patients with an MELD score of 30-39( 23. 5% vs62. 3%,P < 0. 001). Artificial liver support therapy did not significantly shorten the mean hospital stay of the surviving patients( P > 0. 05)and had no significant influence on the total hospital costs of the surviving patients within 90 days( P > 0. 05). The incidence rate of adverse reactions related to artificial liver support therapy was 29. 1%,but the symptoms were mild and were relieved after symptomatic treatment.Conclusion Patients with an MELD score of < 30 in the plateau stage tend to have low 28-and 90-day mortality rates,and artificial liver support therapy can be reasonably selected according to the patient's economic conditions and willingness. Artificial liver support therapy is recommended for patients with an MELD score of 30-39 in the plateau stage if there is no obvious contraindication. For patients with an MELD score of 40 in the plateau stage,artificial liver support therapy is recommended within 28 days if there is no obvious contraindication,and liver transplantation is recommended as soon as possible. Artificial liver support therapy has no significant influence on the total hospital costs and mean hospital stay of the surviving patients within 90 days and does not increase the economic burden of patients.
- liver failure /
- liver,artificial /
- plasma exchange /
- prognosis

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参考文献(24)

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