肝衰竭患者胃气定量评估及其与预后的关系

目的:建立胃气损伤的量化评分表,进行信度和效度的检验;探讨肝衰竭患者胃气损伤与预后的关系。方法:①采用前瞻性多中心病例队列随访研究,观察136例肝衰竭患者入院起1、3、6个月的胃气损伤评分和血清生化学指标、终末期肝病模型(MELD)评分、生存状况;②根据食欲减退程度、腹胀程度、胃气上逆程度、腹泻程度、乏力程度、神色、营养状况、舌苔望诊等8项指标制订胃气评估量表,进行信度检验;制订具有中医特色的肝衰竭预后判断模型,并与MELD模型进行对照。结果:①该胃气评估量表具有稳定性和一致性。②胃气损伤评分与MELD评分的呈正相关。相关系数r=0.323,P<0.01。同时肝衰竭死亡组与存活组之间胃气1评分、MELD1评分差异具有显著意义;③胃气1模型作为死亡风险预测的ROC曲线下面积为0.663,P=0.001。当胃气损伤评分为11分时,其预测死亡风险的灵敏度为62%,特异性为60%。结论:该胃气评估量表简便实用,经内在信度检验,具有稳定性和一致性;胃气损伤评分与MELD评分呈正相关;该胃气评估量表及中医预测模型可预测肝衰竭疾病近期死亡风险。

Gastric qi quantitative assessment and its influence on prognosis in liver failure patients

Objective: Establishing a quantitative evaluation model of gastric qi damage,examining the reliability and validity of the model,exploring the relativity between gastric qi damage and prognosis in liver failure patients.Methods: ①Studying 136 cases of liver failure with a prospective multicenter cases queue follow-up study.While observing the indexes including gastric qi injurydamage scores,indexes of serum biochemistry,MELD scores and living condition for 1,3,6 months from admission.②The damaged degree of gastric qi is graded according to the 8 indexes including’degree of the appetite fails’,’degree of abdominal distension’,’adverse rising of gastric qi degrees’,’degree of diarrhoea’,’degree of weakness ’,’inspection of spirit,color and skin’,’nutritional status’,’observation of tongue fur’,and analysised the reliability;To work out the judgment model of prognosis of liver failure with TCM characteristics,and compare it with MELD model.Results: ①The’ gastric qi’scale has the sablility and concordance.②The scores of gastric qi damages are positive correlated with the scores of MELD.r=0.323,P<0.01.At the same time,there is remarkable difference of the scores of gastric qi damages and MELD scores between the death group and survive group.③The area under curve(AUC) of gastric qi model is 0.663,P=0.001.When the score of gastric qi damage is 11,it predicts the sensitivity of the death risk is 62%,the specificity is 60%.Conclusion: The scale of gastric qi injury on liver failure patients is simple and practica,and has stability and consistency by inherent reliability analysis.The score of gastric qi damages has positive correlation with MELD scores;The gastric qi injury score and TCM predictive model could predict the death risk of of liver failure patients in the near future.