摘要
目的探讨终末期肝病模型(MELD)评分联合系统免疫炎症指数(SII)在失代偿期肝硬化患者预后评估中的作用。方法回顾性分析2015年1月至2019年12月南京大学医学院附属鼓楼医院诊治的378例失代偿期肝硬化患者的临床资料。通过电子病历系统收集患者首次入院时临床资料,根据随访1年时患者预后状况分为死亡组118例(31.22%)、存活组260例(68.78%)。多因素Logistic回归分析失代偿期肝硬化患者死亡的危险因素。ROC曲线分析各指标预测失代偿期肝硬化患者死亡的临床效能。结果死亡组年龄>60岁、合并上消化道出血的比例以及Child-Turcotte-Pugh(CTP)评分、SII、MELD评分高于存活组(P均<0.05),淋巴细胞、血小板、Alb低于存活组(P均<0.05);两组白细胞、C反应蛋白、血肌酐等差异均无统计学意义(P>0.05)。CTP评分(OR=1.48,95%CI:1.12~1.97,P=0.025)、SII(OR=1.33,95%CI:1.05~1.82,P=0.014)、MELD评分(OR=1.86,95%CI:1.13~3.79,P=0.006)是失代偿期肝硬化患者死亡的独立危险因素。MELD联合SII预测失代偿期肝硬化患者死亡的AUC[0.883(95%CI:0.828~0.938,P=0.000)]高于CTP联合SII[0.811(95%CI:0.754~0.867,P=0.000)]。结论CTP评分、MELD评分、SII升高是失代偿肝硬化患者死亡独立危险因素,MELD评分、SII联合应用预测失代偿肝硬化患者死亡的价值高于CTP评分、SII联合。
Objective To explore the role of moldel for end-stage liver disease(MELD)score combined with systemic immuneinflammation index(SII)in the prognosis assessment of patients with decompensated liver cirrhosis.Methods A retrospective analysis of the clinical data of 378 patients with decompensated liver cirrhosis in our hospital from January 2015 to December 2019.According to the prognosis of the patients during the 1-year follow-up,they were divided into 118 cases(31.22%)in the death group and 260 cases(68.78%)in the survival group.The clinical data of the two groups at admission were collected through the electronic medical record system,and multivariate Logistic regression analysis was used to analyze the risk factors of death in patients with decompensated liver cirrhosis.The ROC curve was used to analyze the clinical efficacy of each index in predicting the death of patients with decompensated liver cirrhosis.Results Univariate analysis showed that the older than 60 years old,the proportion of upper gastrointestinal bleeding,Child-Turcotte-Pugh(CTP)score,SII,MELD score,etc.in the death group were higher than those in the survival group(P<0.05),lymphocytes and platelets,Alb was lower than the survival group(P<0.05),and there were not significant differences of white blood cells,C-reactive protein,and serum creatinine between the two groups(P>0.05).The multivariate Logistic regression analysis showed that CTP score(OR=1.48,95%CI:1.12-1.97,P=0.025),SII(OR=1.33,95%CI:1.05-1.82,P=0.014),MELD score(OR=1.86,95%CI:1.13-3.79,P=0.006)were independent risk factors for death in patients with decompensated cirrhosis.ROC curve analysis showed that the AUC[0.883(95%CI:0.828-0.938,P=0.000)]of MELD combined with SII to predict the death of patients with decompensated liver cirrhosis was higher than that of CTP combined with SII[0.811(95%CI:0.754-0.867,P=0.000)].Conclusion Elevated MELD and SII are independent risk factors for death in patients with decompensated cirrhosis.The combined application of the two is more valuable than CTP score combined with SII in predicting death in patients with decompensated cirrhosis.
作者
陆素芳
周红
王丹丹
陈益群
赵红利
张勇杨
LU Su-fang;ZHOU Hong;WANG Dan-dan;CHEN Yi-qun;ZHAO Hong-li;ZHANG Yong-yang(Department of Infectious Diseases,Gulou Hospital,Nanjing University School of Medicine,Nanjing 210008)
出处
《现代消化及介入诊疗》
2021年第8期973-977,共5页
Modern Interventional Diagnosis and Treatment in Gastroenterology
基金
江苏省医学创新团队项目(CXTDA2017005)。
关键词
肝硬化
失代偿期
系统免疫炎症指数
终末期肝病模型
Liver cirrhosis
Decompensated stage
Systemic immune-inflammatory index
End-stage liver disease model
