重庆地区急性肝衰竭病因和结局分析

目的了解重庆地区急性肝衰竭（acute liver failure，ALF）的病因和结局，评价英国皇家学院（King’s College Hospital，KCH）标准和终末期肝病模型（modelforend-stage liver disease，MELD）评分对其结局的判断价值。方法回顾性分析第三军医大学西南医院1999年12月-2008年4月国际标准化比值≥1．5，且伴有肝性脑病的ALF住院患者的病因与结局，用KCH标准和MELD评分预测患者的结局。结果共323例符合标准，纳入研究。270例（83．6％）病因为HBV感染，22例（6．8％）病因不明，16例（5．0％）为药物引起，15例（4．6％）由其他原因引起。24例（7．4％）失访。获随访的299例中，240例（80．3％）死亡，59例（19．7％）自然康复。KCH标准预测ALF患者死亡或存活的灵敏度、特异度、阳性预测值、阴性预测值和正确率分别为74．2％、64．4％、89．4％、38．0％和72．2％；MELD评分预测AIJF患者死亡或存活的上述指标分别为82．1％、61．0％、89．5％、45．6％和77．9％。结论重庆地区AIF的主要病因为HBV感染，KCH标准和MELD评分预测患者结局的阳性预测值较高，MELD评分的预测正确率高于KCH标准。

Etiology and outcome for acute liver failure in Chongqing,China

Objective To understand the etiology and outcome of patients with acute liver failure （ALF） in Chongqing, China and evaluate diagnostic accuracy of King＇s College Hospital （KCI-I） criteria and model for end-stage liver disease （MELD） score in predicting the outcome. Methods The etiology and outcome of ALF patients with international normalized ratio （INR） of ≥1.5 and encephalopathy, who were admitted to southwest hospital affiliated to the third military medical university, from Dec. 1999 to Apr. 2008, were retrospectively analyzed. KCH criteria and MELD score were used to predict the outcome. Results A total of 323 patients were included in the study. HBV infection was the most frequent cause of ALF （270 patients, 83.6% ）, followed by unknown origin （22 patients, 6.8%）, drugs （16 patients, 5.0%） and other causes （15 patients, 4.6%）. Twenty-four patients （7.4%） were lost to followup. Among the 299 patients who were followed up, 240 （80.3%） died and 59 （19.7%） survived spontaneously. Sensitivity, specificity, positive predictive value （PPV）, negative predictive value （NPV） and predictive accuracy of KCH criteria in predicting the outcome were 74.2%, 64.4%, 89.4%, 38.0% and 72.2%, respectively. Those of MELD score were 82.1%, 61.0%, 89.5%, 45.6% and 77.9%, respectively. Conclusions HBV infection is the most common cause in ALF patients in Chongqing. Both KCH criteria and MELD score have a high PPV in predicting the outcome. MELD score has higher predictive accuracy as compared with KCH criteria.