血清前白蛋白和MELD评分对失代偿期乙型肝炎肝硬化患者预后的预测价值*

doi:10.3969/j.issn.1672-5069.2018.03.008

摘要/Abstract

摘要： 目的研究应用血清前白蛋白（PA）水平联合终末期肝病模型（MELD）评分预测失代偿期乙型肝炎肝硬化患者预后的临床价值。方法 2015年12月~2016年12月我院治疗的失代偿期乙型肝炎肝硬化患者231例,随访6个月。常规检测血清PA水平、计算MELD评分和Child-Pugh评分（CTP评分）,在MELD评分的基础上,加入PA项目的评分,建立MELD联合PA评分模型。应用受试者工作特征曲线（ROC）分析各指标对患者死亡的预测效能。结果在随访的6个月里,死亡83例;死亡组血清PA水平为（32.2±9.3）mg/L,显著低于生存组的[（47.3±26.4） mg/L,P<0.05];死亡组MELD评分为（24.1±5.6）分,明显高于生存组的[（18.0±6.7）分,P<0.05];死亡组CTP评分为（11.8±1.2）分,明显高于生存组的[（9.0±2.0）分,P<0.05];ROC曲线分析结果显示,MELD评分预测死亡的ROC下面积（AUC）为0.868（95%CI：0.823~0.912）,显著高于CTP评分的[0.753（95%CI：0.690~0.816）,P<0.05]或血清PA的[0.675（95%CI：0.606~0.743）,P<0.05];进一步采用MELD联合PA评分分析的AUC为0.896（95%CI：0.857~0.935）,显著高于MELD评分（P<0.05）。结论应用血清PA联合MELD评分对失代偿期乙型肝炎肝硬化患者6个月内死亡的预测效能显著高于MELD评分或CTP评分,其临床应用价值还需要扩大验证。

关键词: 肝硬化, 血清前白蛋白, 终末期肝病模型评分, 预测预后

Abstract: Objective To investigate the predictive efficacy of serum prealbumin （PA） combined with model of end-stage liver disease（MELD） score in the prognosis of patients with decompensated hepatitis B-induced liver cirrhosis. Methods 231 patients with decompensated liver cirrhosis and hepatitis B were recruited in our hospital between December 2015 and December 2016,and all of them were followed-up for six months. Serum PA levels were collected and the MELD score and CTP score were calculated,and MELD/PA model was established. The area under curve of receiver operating characteristic （AUC） was applied to estimate the efficacy of prognosis. Results A total of 83 patients died during the 6-month follow-up period;serum PA content in the dead group was（32.2±9.3） mg/L,significantly lower than[（47.3±26.4）mg/L,P<0.05] in the survival group;the MELD score was（24.1±5.6）,significantly higher than[（18.0±6.7）,P<0.05] in the survival;the CTP score was （11.8±1.2）,significantly higher than [（9.0±2.0）,P<0.05] in the survival;the ROC analysis showed that the AUC of MELD score was 0.868 （95%CI:0.823-0.912）,much higher than[0.753（95%CI:0.690-0.816）,P<0.05] by CTP score,or [0.675（95%CI:0.606-0.743）,P<0.05] by serum PA;further comparison analysis result showed that the AUC of MELD/PA score was 0.896（95%CI:0.857-0.935）,significantly higher than by MELD（P<0.05）. Conclusion The application of serum PA levels combined with MELD score in predicting the 6 month prognosis of patients with decompensated hepatitis B liver cirrhosis is feasible,which needs further investigation.

Key words: Liver cirrhosis, Prealbumin, Model of end-stage liver disease, Predictive efficacy

贾克丽, 韩际奥, 高晓. 血清前白蛋白和MELD评分对失代偿期乙型肝炎肝硬化患者预后的预测价值*[J]. 实用肝脏病杂志, 2018, 21(3): 348-351.

Jia Keli, Han Ji’ao, Gao Xiao. Predictive efficacy of serum prealbumin combined with model of end-stage liver disease score in the prognosis of patients with decompensated hepatitis B-induced liver cirrhosis[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(3): 348-351.

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