MELD评分联合血清胱抑素C和ALBI评分诊断失代偿期肝硬化患者并发肝肾综合征价值研究*

doi:10.3969/j.issn.1672-5069.2026.02.022

摘要/Abstract

摘要： 目的探讨终末期肝病模型(MELD)评分、白蛋白-胆红素(ALBI)评分和血清胱抑素C(Cys-C)联合预测失代偿期肝硬化并发肝肾综合征-急性肾损伤(HRS-AKI)的价值。方法 2020年10月～2025年4月我院收治的HRS-AKI患者99例和失代偿肝硬化住院患者117例,应用医院信息管理(HIS)系统收集临床基线资料、血生化指标和血清Cys-C水平,计算MELD和ALBI评分。应用二元Logistic 回归分析影响并发HRS-AKI的因素,应用受试者工作特征曲线(ROC)评估各指标对HRS-AKI的诊断效能。结果 99例住院期间发生HRS-AKI患者血清Cys-C水平、MELD评分和ALBI评分分别为2.4(1.6,3.3)mg/L、19.9(11.8,24.3)和-1.1(-1.5,-0.6),均显著高于肝硬化组【分别为1.1(0.9,1.4)mg/L、10.9(7.4,14.5)和-1.4(-1.5,-0.9),P＜0.05】;Logistic回归分析显示,凝血酶原时间是影响肝硬化患者并发HRS-AKI的保护因素(OR=0.852,95%CI=0.752～0.964,P＜0.05),而血清Cys-C(OR=42.318,95%CI=13.179～135.888,P＜0.001)、MELD评分(OR=25.539,95%CI=4.266～152.892,P＜0.001)和并发肝性脑病(OR=4.527,95%CI=1.283～15.969,P＜0.05)是独立危险因素;ROC分析显示,血清Cys-C联合MELD评分和ALBI评分诊断HRS-AKI的AUC为0.918(95%CI:0.877～0.959),其效能较高。结论监测血清Cys-C水平联合MELD评分和ALBI评分可以帮助临床医师更加明确诊断住院的失代偿肝硬化患者并发HRS-AKI,值得进一步研究。

关键词: 肝硬化, 肝肾综合征, 胱抑素C, 终末期肝病模型, 白蛋白-胆红素评分, 诊断

Abstract: Objective The purpose of this study was to investigate the diagnosticefficacy of serum cystatin C (Cys-C), model for end-stage liver disease (MELD) and albumin-bilirubin (ALBI) score combination for hepatorenal syndrome-acute kidney injury (HRS-AKI) in patients with decompendated liver cirrhosis (DLC). Methods 99 patients with HRS-AKI and 117 hospitalized patients with DLC were encountered in our hospital between October 2020 and April 2025, baseline clinical materials,serum biochemical index and serum Cys-C levels were collectedby retrieving our hospital information management (HIS) system, and MELD and ALBI scores were calculated. Binary Logistic regression analysis was appliedto identify factors influencing the occurrence of HRS-AKI, and receiver operating characteristic (ROC) curves were employed to evaluate the diagnostic efficacy for HRS-AKI. Results Serum Cys-C levels, MELD and ALBI scores in patients with HRS-AKI were 2.4 (1.6, 3.3) mg/L, 19.9 (11.8, 24.3) and -1.1 (-1.5, -0.6), all significantly higher than [1.1 (0.9, 1.4) mg/L, 10.9 (7.4, 14.5) and -1.4 (-1.5, -0.9), respectively, P<0.05] in the cirrhosis group; Logistic regression analysis revealed that prothrombin time was a protective factor against HRS-AKI in patients with DLC (OR = 0.852, 95% CI = 0.752-0.964, P<0.05), while serum Cys-C level (OR = 42.318, 95% CI = 13.179-135.888, P<0.05), MELD score (OR = 25.539, 95% CI = 4.266-152.892, P<0.05) and concurrent hepatic encephalopathy (OR = 4.527, 95% CI = 1.283-15.969, P<0.05) were the independent risk factors; ROC analysis showed that the AUC was 0.918 (95% CI: 0.877-0.959), when combination of serum Cys-C level, MELD and ALBI score was set for diagnosing HRS-AKI. Conclusion Serum Cys-C levels in combination with MELD and ALBI scores could assist clinicians for the early diagnosis of HRS-AKI in hospitalized patientswith DLC, which warrants further study.

Key words: Liver cirrhosis, Hepatorenal syndrome, Cystatin C, Model for end-stage liver disease, Albumin-bilirubin score, Diagnosis

孙博汉, 曹春莉, 奇丽娜. MELD评分联合血清胱抑素C和ALBI评分诊断失代偿期肝硬化患者并发肝肾综合征价值研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 249-252.

Sun Bohan, Cao Chunli, Qi Lina. Predictive efficacy of serum cystatin C, MELD and ALBI score combination for hepatorenal syndrome-acute kidney injury in patients with decompendated liver cirrhosis[J]. Journal of Practical Hepatology, 2026, 29(2): 249-252.

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MELD评分联合血清胱抑素C和ALBI评分诊断失代偿期肝硬化患者并发肝肾综合征价值研究^*

Predictive efficacy of serum cystatin C, MELD and ALBI score combination for hepatorenal syndrome-acute kidney injury in patients with decompendated liver cirrhosis

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