HBV相关慢加急性肝衰竭预后简易评分系统的建立 |
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引用本文: | 厉新妍,黄淑琳,方亮,雷瑞祥,柯伟民.HBV相关慢加急性肝衰竭预后简易评分系统的建立[J].临床肝胆病杂志,2014(10):996-999. |
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作者姓名: | 厉新妍 黄淑琳 方亮 雷瑞祥 柯伟民 |
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作者单位: | 1. 广州市第一人民医院 感染科,广州,510180 2. 广州市华南师范大学数学科学学院,广州,510631 3. 广州市中山大学附属第三医院 感染科,广州,510630 |
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基金项目: | 广州市医药卫生科技项目(201102A213093);广东省医学科学技术研究基金 |
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摘 要: | 目的建立HBV相关慢加急性肝衰竭(HBV-ACLF)严重度简易评分系统。方法收集620例HBV-ACLF患者的临床资料,选择肝性脑病、血清肌酐、血清总胆红素、凝血酶原活动度、感染、肝脏大小、腹水液平等7个临床指标,应用统计学方法并结合临床实际,确定各指标从0~4分评分界点,并累计总分。据此建立模型并确定诊断界点,对此评分模型进行验证。结果对HBV-ACLF患者临床资料进行统计学分析,交互卡方检验确定各指标评分分值并建立模型。将500例患者分为生存组和死亡组。两组间评分差异有统计学意义(t=25.78,P0.001)。受试者工作特征曲线(ROC曲线)下面积0.963,最佳临界值9.5,灵敏度0.98,特异度0.83。120例患者对其进行验证,≥10分预后差,病死率为84.3%,≤9分组预后好,病死率为3.5%。两组病死率比较差异有统计学意义(χ2=72.2,P0.001)。结论本评分系统可用于HBV-ACLF预后评估,具有简易、敏感、客观的优点。
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关 键 词: | 肝炎病毒 乙型 肝功能衰竭 预后 |
A simple scoring system for evaluating severity of HBV -related acute -on -chronic liver failure |
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Institution: | LI Xinyan, HUANG Shulin, FANG Liang, et al. ( Department of Infectious Diseases, Guangzhou First Municipal People's Hospital, Guang- zhou 510180, China) |
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Abstract: | Objective To establish a simple scoring system for evaluating the severity of hepatitis B virus (HBV)-related acute -on -chronic liver failure (HBV -ACLF).Methods A retrospective analysis was performed on the clinical data of 620 patients with HBV -ACLF who were divided into group I (500 patients)and group II (120 patients).Seven clinical parameters,including hepatic encephalopa-thy,serum creatinine,prothrombin activity,serum total bilirubin,infection,dimension of liver,and maximum depth of ascites,were scored from 0 -4 points for each patient according to the disease severity.The severity scoring system was established based on the total score of each patient in group I,with the cut -off point being determined.The established system was tested with group II.Results A severity sco-ring system was successfully developed based on chi -squared automatic interaction detector analysis of the total score of each patient in group I.There was a significant difference in the total score between the survival and death subgroups of the 500 patients (t =25.78,P 〈0.001).The area under the ROC curve was 0.963,suggesting a high validity of this scoring system.With the cut -off value of 9.5,the sensitivity and specificity of this system were 0.98 and 0.83,respectively.The other 120 patients were divided into the poor prognosis (score ≥10)and good prognosis subgroups (score ≤9)based on the scoring system,with the mortality rates being 84.3% and 3.5%,re-spectively;there was a significant difference in mortality between the two subgroups (χ2 =72.2,P <0.001 ).Conclusion This scoring system is simple,sensitive,and objective to evaluate the severity of HBV -ACLF. |
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Keywords: | hepatitis B virus liver failure prognosis |
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