摘要
目的探讨终末期肝病模型(MELD)-甲胎蛋白(AFP)联合评分等对慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)患者预后的预测价值,并分析该病患者预后的影响因素。方法回顾性分析2015年9月—2021年9月青岛大学附属医院和青岛市第六人民医院收治的ACLF患者的临床资料,根据确诊第90天时预后情况分为存活组和死亡组,分析ACLF患者预后的影响因素,并分析血清AFP、MELD评分及MELD-AFP联合评分在患者短期预后预测方面的效能。结果共纳入159例ACLF患者,确诊第28天时存活患者129例,死亡患者30例;确诊第90天时存活患者111例,死亡患者48例。血清AFP水平、乳酸脱氢酶水平、红细胞计数、血红蛋白水平、谷丙转氨酶/谷草转氨酶(谷丙/谷草)比值、尿素氮/肌酐比值、MELD评分是影响ACLF患者确诊第90天时预后的独立因素。与MELD评分相比,MELD-AFP评分对ACLF患者确诊第90天时的存活情况预测效能更好(AUC=0.81)。结论血清乳酸脱氢酶水平、尿素氮/肌酐比值、谷丙/谷草比值、红细胞计数、血清AFP水平、血清血红蛋白水平升高与ACLF患者确诊后第90天时的预后情况密切相关。MELD-AFP联合评分能够明显优化传统MELD评分在ACLF患者短期预后方面的预测效能。
Objective To investigate the value of the combined score of Model for End-Stage Liver Disease(MELD)and alpha-fetoprotein(AFP)in predicting the prognosis of patients with acute-on-chronic liver failure(ACLF)and the influencing factors for the prognosis of patients with ACLF.Methods A retrospective analysis was performed for the clinical data of the patients with ACLF who were admitted to The Affiliated Hospital of Qingdao University and The Qingdao Sixth People’s Hospital from September 2015 to September 2021,and according to the prognosis on day 90 after diagnosis,they were divided into survival group and death group.The influencing factors for the prognosis of ACLF patients were analyzed,as well as the performance of serum AFP level,MELD score,and MELD-AFP combined score in predicting the short-term prognosis of patients.Results A total of 159 patients with ACLF were enrolled;129 patients survived and 30 patients died on day 28 after diagnosis,while 111 patients survived and 48 patients died on day 90 after diagnosis.Serum AFP level,lactate dehydrogenase level,red blood cell count,hemoglobin level,alanine aminotransferase/aspartate aminotransferase ratio,urea nitrogen/creatinine ratio,and MELD score were independent influencing factors for the prognosis of ACLF patients on day 90 after diagnosis.Compared with MELD score,MELD-AFP combined score had better performance in predicting the prognosis of ACLF patients on day 90 after diagnosis,with an area under the ROC curve of 0.81.Conclusion Increases in serum lactate dehydrogenase level,urea nitrogen/creatinine ratio,alanine aminotransferase/aspartate aminotransferase ratio,red blood cell count,serum AFP level,and serum hemoglobin level are closely associated with the prognosis of ACLF patients on day 90 after diagnosis.MELD-AFP combined score significantly optimizes the performance of traditional MELD score in predicting the short-term prognosis of ACLF patients.
作者
张蒲阳
刘丽娟
李金金
蔡金贞
苟卫
许传屾
牛庆慧
ZHANG Puyang;LIU Lijuan;LI Jinjin;CAI Jinzhen;GOU Wei;XU Chuanshen;NIU Qinghui(Department of Hepatology,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)
出处
《精准医学杂志》
2023年第5期391-395,399,共6页
Journal of Precision Medicine
基金
北京肝胆相照公益基金会项目资助(RGGJJ-2021-027)。
关键词
慢加急性肝功能衰竭
模型
理论
终末期肝病
甲胎蛋白类
预后
危险因素
Acute-on-chronic liver failure
Model,theory
End-stage liver disease
Alpha-fetoprotein
Prognosis
Risk factors
