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

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。

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

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.