摘要
目的探讨终末期肝病模型(model for end-stage liver disease,MELD)评分联合PLT对乙型肝炎引起的慢加急性肝衰竭(HBV related acute-on-chronic liver failure,HBV-ACLF)患者入院28 d预后的评估价值。方法将2015-2017年首都医科大学附属北京佑安医院收治的102例HBV-ACLF患者分为28 d存活组和28 d内肝移植/死亡组,进行肝功能、血常规、凝血功能及乙型肝炎病毒载量检测,寻找与预后相关的指标并进行分析。结果单因素分析显示,年龄、T-BIL、ALB、BUN、Cr、PT、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、INR、凝血酶原活动度(prothrombin time activity,PTA)、PLT、中性粒细胞与淋巴细胞比值(neutrophil-lymphocyte ratio,NLR)、白蛋白-胆红素(albumin-bilirubin,ALBI)评分、MELD评分可影响慢加急性肝衰竭患者入院28 d预后,入院28 d内肝移植/死亡组患者年龄、T-BIL、BUN、Cr、PT、APTT、INR、NLR、ALBI评分、MELD评分较28 d存活组高,而ALB、PTA、PLT较28 d存活组低,差异均有统计学意义(P<0.05);多因素分析显示,MELD评分和PLT为影响ACLF患者入院28d预后的独立危险因素,二者联合评估ACLF患者28 d预后,ROC曲线下面积为0.871,敏感度为81.8%,特异度为80.4%。结论 MELD评分联合PLT对于评估HBV-ACLF患者28 d预后具有一定价值。
Objective To explore the value of model for end-stage liver disease （MELD） score combined with platelet count in evaluating the short-term prognosis of patients with acute-on-chronic liver failure caused by hepatitis B. Methods The liver function, blood routine, blood coagulation function and hepatitis B virus load were detected in 102 patients with acute-on-chronic liver failure caused by hepatitis B, and the related prognostic markers were analyzed. Results Univariate analysis showed that age, total bilirubin, albumin, urea, creatinine, prothrombin time, activated partial thromboplastin time, international normalized ratio, prothrombin time activity, platelet count, neutrophil-lymphocyte ratio, ALBI score, MELD score could affect the 28-day prognosis of patients with acute-on-chronic liver failure. And the age, total bilirubin, urea, creatinine, prothrombin time, activated partial thromboplastin time, international normalized ratio, neutrophillymphocyte ratio, ALBI score, MELD score of liver transplantation/death patients within 28 days of admission were higher than those of 28-day survival group, while the albumin, prothrombin time activity and platelet count were lower than those of the 28-day survival group, the difference was statistically significant （P 〈 0.05）. Multivariate analysis showed that MELD score and platelet count were independent risk factors for 28-day prognosis in patients with acute-on-chronic liver failure, when MELD score and platelet count were combined, the ROC curve area was 0.871, the sensitivity was 81.8%, the specificity was 80.4%. Conclusion MELD score combined with platelet count has a certain value in evaluating the 28-day prognosis of patients with acute-on-chronic liver failure.
作者
高梦丹
侯玉丽
覃岭
孙坚萍
王文静
李昂
房忠军
于艳华
娄金丽
张永宏
赵艳
Gao Mengdan;Hou Yuli;Qin Lin;Sun Jianping;Wang Wenjing;Li Ang;Fang Zhongjun;Yu Yanhua;Lou Jinli;Zhang Yonghong;Zhao Yan(Clinical Laboratory Center, Beijing You＇an Hospital, Capital Medical University, Beijing 100069, China)
出处
《北京医学》
CAS
2018年第4期293-296,共4页
Beijing Medical Journal
基金
北京市医院管理局临床医学发展专项--"扬帆"计划(ZYLX201711)
传染病相关疾病生物标志物北京市重点实验室(BZ0373)
丰台区科技项目(BJYAH2015YN15)
