血清内毒素与整合终末期肝病模型在判断失代偿期肝硬化患者中短期预后中的应用

目的 探讨血清内毒素与整合终末期肝病模型（iMELD）在判断失代偿期肝硬化患者中短期预后中的应用价值.方法 回顾性分析68例失代偿期肝硬化患者的临床资料,依据随访3,6,12个月的生存状况,将患者列入生存组与死亡组,根据有关实验室检测指标的结果计算两组iMELD评分和Child-Turcotte-Pugh（CTP）评分,检测血清内毒素水平,分析血清内毒素与iMELD评分在失代偿期肝硬化患者中短期预后中的相关性.结果 随访3个月,5例患者死亡,生存组、死亡组的iMELD评分分别为（39.26±7.29）,（49.29±8.63）分,CTP评分分别为（9.32±2.12）,（12.03±2.75）分,血清内毒素水平分别为（9.21±2.24）,（15.39±5.12） ng/L,两组比较差异有统计学意义（P＜0.05）.随访6个月,12例患者死亡,生存组、死亡组iMELD评分分别为（41.35±8.03）,（52.18±10.37）分,CTP评分分别为（9.78±2.05）,（12.93±1.99）分,血清内毒素水平分别为（8.96±2.41）,（16.43±6.03） ng/L,两组比较差异有统计学意义（P＜0.05）.随访12个月,19例患者死亡,生存组、死亡组iMELD评分分别为（40.74 ±6.38）,（52.29±8.53）分,CTP评分分别为（10.01±2.23）,（13.27±1.69）分,血清内毒素水平分别为（8.53±2.34）,（16.52 ±6.08） ng/L,两组比较差异有统计学意义（P＜0.05）.受试者工作特征曲线下面积为0.952,标准误为0.048,95％可信区间为0.790～ 1.022.iMELD评分预测失代偿期肝硬化患者死亡的最佳临界值为≥48.00分,iMELD评分增高患者死亡风险增加;血清内毒素预测患者死亡的最佳临界值为≥11.00 ng/L.结论 血清内毒素水平与iMELD评分对判断肝硬化失代偿期患者预后有较高的应用价值.

The application of serum endotoxin combined with integrated model for end-stage liver disease in evaluating the short and medium term prognosis of patients with decompensated liver cirrhosis

Objective To evaluate the application value of serum endotoxin combined with integrated model for end-stage liver disease （iMELD） in evaluating the short and medium term prognosis of patients with decompensated liver cirrhosis.Methods The clinical data of 68 patients with decompensated liver cirrhosis were retrospectively analyzed.The patients were divided into survival group and death group according to the result of follow-up at the 3,6 and 12 months.The iMELD score and Child-Turcotte-Pugh （CTP） score were calculated according to relevant indicators,and the serum endotoxin level was detected.The correlation between serum endotoxin and iMELD score was analyzed in the short and medium term prognosis in patients with decompensated liver cirrhosis.Results After 3 months＇ follow-up,5 patients died.The iMELD scores in survival group and death group were （39.26 ± 7.29） and （49.29 ± 8.63） scores,CTP scores were （9.32 ± 2.12） and （12.03 ± 2.75） scores,serum endotoxin levels were （9.21 ± 2.24） and （15.39 ± 5.12） ng/L,and there were statistical differences （P 〈 0.05）.After 6 months＇follow-up,12 patients died.The iMELD scores in survival group and death group were （41.35 ± 8.03） and （52.18 ± 10.37） scores,CTP scores were （9.78 ± 2.05） and （12.93 ± 1.99） scores,serum endotoxin levels were （8.96 ± 2.41） and （16.43 ±6.03） ng/L,and there were statistical differences （P 〈0.05）.After 12 months＇ follow-up,19 patients died.The iMELD scores in survival group and death group were （40.74 ± 6.38） and （52.29 ± 8.53） scores,CTP scores were （10.01 ± 2.23） and （13.27 ± 1.69） scores,serum endotoxin levels were （8.53 ± 2.34） and （16.52 ± 6.08） ng/L,and there were statistical differences （P 〈 0.05）.The area under curve of receiver operating characteristic （ROC） was 0.952,standard error was 0.048,and 95% confidence interval was 0.790-1.022.The best critical value of iMELD score to predict death was ≥48.00 scores,and