不同肝病基础的慢加急性肝衰竭患者临床特征和预后评分模型预测效能比较

doi:10.3969/j.issn.1672-5069.2021.03.021

实用肝脏病杂志 ›› 2021, Vol. 24 ›› Issue (3): 387-390.doi: 10.3969/j.issn.1672-5069.2021.03.021

不同肝病基础的慢加急性肝衰竭患者临床特征和预后评分模型预测效能比较

孔雪杰, 李江, 李昊天, 李绪桐, 郜玉峰

230022 合肥市安徽医科大学第一附属医院感染病科

收稿日期:2020-12-25 出版日期:2021-05-30 发布日期:2021-04-30
通讯作者: 郜玉峰,E-mail:aygyf@126.com
作者简介:孔雪杰,女,27岁,硕士研究生,规培医师。主要从事病毒性肝炎临床防治研究。E-mail:kongxuejie2013@163.com
基金资助:
安徽省中央引导地方科技发展项目(编号:201907d07050008);合肥市借转补基金项目(编号:J2019Y04)

Clinical feature and efficacy of different prognostic scoring models in patients with acute-on-chronic liver failure with different underlying liver diseases

Kong Xuejie, Li Jiang, Li Haotian, et al

Department of Infectious Diseases, First Affiliated Hospital, Anhui Medical University, Hefei 230022, Anhui Province, China

Received:2020-12-25 Online:2021-05-30 Published:2021-04-30

摘要/Abstract

摘要： 目的探讨不同肝病基础的慢加急性肝衰竭(ACLF)患者临床特征及其各预后评分模型对病情判断的价值。方法采用回顾性队列研究分析2017年1月～2018年12月我院收治的262例ACLF患者的临床资料,排除70例,在纳入的192例患者中,其肝病基础分别为非肝硬化慢性肝病(A组,n=54)、代偿期肝硬化(B组,n=87)和失代偿期肝硬化(C组,n=51)。分别采用Child-Pugh评分、MELD评分、欧洲肝病学会慢性肝衰竭研究组CLIF-C ACLF评分模型和中国重型乙型肝炎研究组(COSSH)模型预测28 d和90 d生存情况。结果三组性别、年龄和病因构成比相比,均无显著性差异(P>0.05);三组血清TBIL和INR均无显著性差异(P >0.05);C组腹水和细菌感染发生率分别为70.6%和47.1%,显著高于B组的62.1%和33.3%或A组的40.7%和22.2%(P <0.05);A组28 d和90 d生存率分别为63.0%和59.3%,与B组的69.0% 和57.5%或C组的56.9%和47.1%比,均无显著性差异(P >0.05);血清TBIL、Cr、INR和肝性脑病是ACLF患者90 d死亡的影响因素;MELD、CLIF-C ACLFs和COSSH-ACLFs模型预测生存的效能显著优于Child-Pugh评分,而以MELD评分的效能最优。结论不同肝病基础的ACLF患者临床特征和并发症存在差异,预后也存在一定的差异,可能需要更长时间的观察。

关键词: 慢加急性肝衰竭, 临床特征, 预后

Abstract: Objective The aim of this study was to investigate the clinical feature and efficacy of different prognostic scoring models in patients with acute-on-chronic liver failure (ACLF) with different underlying liver diseases.Methods The clinical data of 192 patients with ACLF admitted to our hospital between January 2017 and December 2018 were retrospectively analyzed, and out of them, 54 patients had underlying liver disease of chronic hepatitis (group A), 87 had compensated liver cirrhosis (group B) and 51 had decompensated cirrhosis (group C). The Child-Pugh, the model for end-stage liver disease (MELD), the chronic liver failure research group of European society of liver diseases (EASL-CLIF) and Chinese group on the Study of Severe Hepatitis B (COSSH) were applied to predict the prognosis.Results There were no significant differences in gender, age and etiology between the three groups; there were also no significant differences between the three groups as respect to serum total bilirubin and prothrombin time international normalized ratio (INR, P >0.05); the incidence of ascites and bacterial infections in group C were 70.6% and 47.1%, significantly higher than 62.1% and 33.3% in group B or 40.7% and 22.2% in group A (P <0.05); the 28-day and 90-day survival rates in group A were 63.0% and 59.3%, not significantly different as compared to 69.0% and 57.5% in group B or 56.9% and 47.1% in group C (P >0.05); serum bilirubin, creatinine, INR and hepatic encephalopathy were the independent factors impacting the 90 d survival; the performance of MELD, CLIF-C ACLFs and COSSH-ACLFs models in predicting the short-term mortality of patients with ACLF was superior to Child-Pugh score, and the MELD score was the best.Conclusion The clinical features and complications of ACLF patients with different underlying liver diseases are significantly different, and the prognosis of them are also different, which might need long-term observation.

Key words: Acute-on-chronic liver failure, Clinical features, Prognosis

孔雪杰, 李江, 李昊天, 李绪桐, 郜玉峰. 不同肝病基础的慢加急性肝衰竭患者临床特征和预后评分模型预测效能比较[J]. 实用肝脏病杂志, 2021, 24(3): 387-390.

Kong Xuejie, Li Jiang, Li Haotian, et al. Clinical feature and efficacy of different prognostic scoring models in patients with acute-on-chronic liver failure with different underlying liver diseases[J]. Journal of Practical Hepatology, 2021, 24(3): 387-390.

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不同肝病基础的慢加急性肝衰竭患者临床特征和预后评分模型预测效能比较

Clinical feature and efficacy of different prognostic scoring models in patients with acute-on-chronic liver failure with different underlying liver diseases

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