CTP-MELD评分联合血清M30和M65预测乙型肝炎相关慢加急性肝衰竭短期预后的价值

肝脏 ›› 2022, Vol. 27 ›› Issue (1): 58-62.

CTP-MELD评分联合血清M30和M65预测乙型肝炎相关慢加急性肝衰竭短期预后的价值

崔大广, 肖玲燕, 刘永福, 史东阳, 杨凯, 郑以山

210000 南京中医药大学附属南京医院(南京市第二医院)

收稿日期:2021-06-25 出版日期:2022-01-31 发布日期:2022-02-11
通讯作者: 郑以山,Email:Doctor0219@163.com

The predictive value of CTP-MELD scores combined with serum M30 and M65 levels for the short-term prognosis of patients with hepatitis B-related acute-on-chronic liver failure

CUI Da-guang, XIAO Ling-yan, LIU Yong-fu, SHI Dong-yang, Yang kai, ZHENG Yi-shan

Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine (The Second Hospital of Nanjing) Nanjing, Jiangsu 210003, China

Received:2021-06-25 Online:2022-01-31 Published:2022-02-11
Contact: ZHENG Yi-shan,Email: Doctor0219@163.com

摘要/Abstract

摘要： 目的探讨肝功能评分(CTP)-终末期肝病模型(MELD)联合血清M30和M65对乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者短期预后的预测价值。方法选择2017年1月至2020年1月南京市第二医院接受治疗的HBV-ACLF患者106例,根据90 d预后分为生存组51例与死亡组55例。比较两组患者一般情况、实验室指标、血清M30和M65水平,受试者特征曲线分析下面积CTP-MELD评分联合血清M30和M65与HBV-ACLF短期预后的关系。结果死亡组患者的CTP、MELD评分分别为(23.02±5.18)分和(31.18±5.89)分,高于存活组的(10.49±1.05)分和(13.21±1.34)分(t=16.949、21.276,均P<0.01);死亡组的血清M30、M65水平分别为(1685.12±413.32)U/L和(2799.41±712.05)U/L,均高于存活组的(1001.40±316.49)U/L和(1808.85±669.43)U/L(t=9.507、8.608,均P<0.01)。CTP、MELD、M30、M65单独预测90 d病死的AUC分别为0.624(95%CI:0.525~0.716)、0.804(95%CI:0.716~0.875)、0.750(95%CI:0.656~0.829)、0.887(95%CI:0.810~0.940),4项联合的AUC为0.919(95%CI:0.850~0.963),明显优于CTP、MELD、M30单项评价(P<0.05),高于M65单项评价但差异无统计学意义(P>0.05)。结论 CTP、MELD评分和血清M30、M65能够较好地预测HBV-ACLF患者短期预后,且4项联合检测具有更高的预测价值。

关键词: 乙型肝炎病毒, 慢加急性肝衰竭, 肝功能评分, 终末期肝病模型, M30, M65

Abstract: Objective To explore the predictive value of Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores in combination with serum M30 and M65 levels for the short-term prognosis of patients with hepatitis B-related acute-on-chronic liver failure (HBV-ACLF).Methods One hundred and six HBV-ACLF patients admitted to our hospital from January 2017 to January 2020 were selected in this study. They were divided into a survival group (n=51) and a death group (n=55) according to their 90-day’s prognosis. The general conditions and indicators of laboratory test were compared between the patients in these two groups. Serum M30 and M65 levels were detected and CTP and MELD scores were evaluated. The receiver operating characteristic curve (ROC) was used to analyze the value of CTP and MELD scores, and serum M30 and M65 levels in predicting the short-term prognosis of HBV-ACLF patients.Results The CTP and MELD scores of the death group were (23.02±5.18) points and (31.18±5.89) points, respectively, which were significantly higher than those of (10.49±1.05) points and (13.21±1.34) points of the survival group (P<0.05); the serum levels of M30 and M65 in the death group were (1685.12±413.32) U/L and (2799.41±712.05) U/L, respectively, which were significantly higher than those of (1001.40±316.49) U/L and (1808.85±669.43) U/L of the control group (all P<0.05).The AUC of CTP, MELD, M30, and M65 that individually predicted 90-day mortality were 0.624 (95%CI: 0.525~0.716), 0.804 (95%CI: 0.716~0.875), 0.750 (95%CI: 0.656~0.829), and 0.887 ( 95%CI: 0.810~0.940); The AUC of a combination of these four items was 0.919 (95%CI: 0.850~0.963), which was significantly better than CTP, MELD, M30 in individual evaluation (P<0.05), and higher than M65 individual evaluation but no statistical significant difference (P>0.05).Conclusion CTP and MELD scores and serum M30 and M65 levels can predict the short-term prognosis of patients with HBV-ACLF. The combination of these four items is of better predictive value.

Key words: Hepatitis B virus, Acute-on-chronic liver failure, Child-Turcotte-Pugh, Model for end-stage liver disease, M30, M65

崔大广, 肖玲燕, 刘永福, 史东阳, 杨凯, 郑以山. CTP-MELD评分联合血清M30和M65预测乙型肝炎相关慢加急性肝衰竭短期预后的价值[J]. 肝脏, 2022, 27(1): 58-62.

CUI Da-guang, XIAO Ling-yan, LIU Yong-fu, SHI Dong-yang, Yang kai, ZHENG Yi-shan. The predictive value of CTP-MELD scores combined with serum M30 and M65 levels for the short-term prognosis of patients with hepatitis B-related acute-on-chronic liver failure[J]. Chinese Hepatolgy, 2022, 27(1): 58-62.

[1]	胡大山, 刘欢, 宣佶. 服用核苷(酸)类似物停药后乙型肝炎相关慢加急性肝衰竭患者的临床特点分析[J]. 肝脏, 2022, 27(1): 54-57.
[2]	邓浩辉, 楼燕, 高洪波, 陈伟烈. 艾滋病合并HBV相关慢加急肝衰竭患者临床特征和预后分析[J]. 肝脏, 2022, 27(1): 63-67.
[3]	李旭东, 范锡伟, 王丽, 郭振凯. HBV相关慢加急性肝衰竭出血事件预后评价及影响因素分析[J]. 肝脏, 2022, 27(1): 68-71.
[4]	王鑫, 张国民, 牛兴杰, 李萍, 张冰. 外周血NLR、nCD64在HBV相关ACLF继发感染和短期预后中的诊断及预测价值[J]. 肝脏, 2022, 27(1): 72-75.
[5]	张警予, 赵红, 谢雯. 氨基酸在慢加急性肝衰竭病理生理机制中的作用[J]. 肝脏, 2021, 26(9): 958-960.
[6]	李瑞明, 杨燕, 曾宪煌, 孟忠吉. HBV-C基因型复制细胞系的构建与鉴定[J]. 肝脏, 2021, 26(9): 998-1002.
[7]	贲屹然, 陈国林. 免疫抑制治疗相关的慢性乙型肝炎患者HBV再激活与预防[J]. 肝脏, 2021, 26(9): 1041-1043.
[8]	杜凌遥, 马元吉, 吕朵朵, 唐红. 乙型肝炎病毒基因型及其临床意义的研究进展[J]. 肝脏, 2021, 26(9): 1044-1046.
[9]	许梓萌, 李德瑶, 席婧媛, 鲁凤民. 从HBV X蛋白的生物学功能看靶向HBx临床治愈慢性乙型肝炎的可能性[J]. 肝脏, 2021, 26(8): 832-834.
[10]	章晓鹰, 顾超, 马道亮, 张珏, 高月求, 孙学华. HBeAg阴性慢性乙型肝炎患者B、C基因型 HBV S蛋白变异比较[J]. 肝脏, 2021, 26(8): 847-850.
[11]	韩仙芝, 张淑凤, 高广甫, 朱海洋, 高红伟, 孙会卿. 降阶梯、经验性抗生素治疗HBV相关慢加急性肝衰竭合并自发性腹膜炎的效果比较[J]. 肝脏, 2021, 26(8): 892-894.
[12]	张思越, 甘建和. 慢加急性肝衰竭防治的研究进展[J]. 肝脏, 2021, 26(8): 928-931.
[13]	王捷骁, 干沁怡, 谢青. HBsAg定量在HBeAg阴性慢性HBV感染患者中的临床应用及价值[J]. 肝脏, 2021, 26(7): 713-716.
[14]	张秀翠, 李铭龙, 杭小锋, 魏博. 乌司他丁治疗慢加急性肝衰竭的回顾性队列研究[J]. 肝脏, 2021, 26(7): 776-778.
[15]	顾雨玲, 韩冰, 黄沁, 甘建和, 董凤林, 许春芳, 陈友国. 妊娠合并乙肝肝硬化脾静脉破裂1例[J]. 肝脏, 2021, 26(7): 821-823.