MELD评分联合血清降钙素原评估乙型肝炎相关慢加急性肝衰竭患者短期预后的价值

目的探讨MELD评分联合血清降钙素原(PCT)预测乙型肝炎慢加急性肝衰竭(ACLF)患者短期预后的临床价值。方法选取2012年1月至2015年12月于云南省第三人民医院住院的乙型肝炎相关ACLF患者331例,分为生存组(208例)和死亡组(123例),比较两组患者的血清TBil、肌酐(Cr)、国际标准化比值(INR)、血清钠(Na~+)、MELD评分和血清PCT。计量资料两组间比较采用独立样本Mann-Whitney U检验或t检验,计数资料组间比较采用χ~2检验,受试者工作特征曲线下面积(AUC)比较采用正态Z检验。结果死亡组患者的TBil(330.9±81.9)μmol/L比(245.5±67.7)μmol/L、Cr(94.9±23.8)μmol/L比(71.2±29.3)μmol/L、INR(2.5±1.0)μmol/L比(2.1±0.6)μmol/L、MELD评分(26.2±6.5)比(22.0±5.8)、血清PCT浓度(1.3±0.3)μg/L比(0.5±0.2)μg/L均高于生存组,血清Na~+水平(128.9±14.1)mmol/L比(133.8±9.3)mmol/L低于生存组,差异均有统计学意义(均P0.01)。MELD评分、血清PCT预测乙型肝炎相关ACLF患者近期死亡危险性的最佳临界值分别为24.8、0.65μg/L。MELD评分联合血清PCT判断乙型肝炎相关ACLF短期预后的AUC为0.880,高于单独MELD评分的AUC0.820和PCT的AUC0.803,差异均有统计学意义(均P0.01)。结论 MELD评分联合血清PCT对乙型肝炎相关ACLF患者短期预后的预测价值良好。

Predictive value of MELD score combined with serum procalcitonin on the short-term prognosis in patients with HBV-related acute-on-chronic liver failure

Objective To investigate the predictive value of combined model for end-stage liver disease (MELD) score and serum procalcitonin (PCT) on the short-term prognosis in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF).Methods A total of 331 HBV-related ACLF patients from January 2012 to December 2015 in our hospital were respectively analyzed,and divided into survival group (208 cases) and death group (123 cases) according to the prognosis by 3-month follow-up.Serum total bilirubin (TBil),creatinine (Cr),international normalized ratio (INR),serum PCT and MELD score were measured and compared between the two groups.The capability of MELD score combined with serum PCT was evaluated for predicting the short-term prognosis of HBV-related ACLF patients by receiver operating characteristic (ROC) curve.Results In death group,serum levels of TBIL (330.9±81.9 vs 245.5±67.7 μmol/L),Cr (94.9±23.8 vs 71.2±29.3 μmol/L),PCT (1.3±0.3 vs 0.5±0.2 μg/L),INR (2.5±1.0 vs 2.1±0.6) and MELD score (26.2±6.5 vs 22.0±5.8) were significantly higher than those in the survival group,while the serum level of Na+ (128.9±14.1 vs 133.8±9.3 mmol/L) was significantly lower (all P<0.001).The optimal cut-off value of MELD score and serum level of PCT in predicting short-term mortality were 24.8 and 0.65 μg/L.The area under the ROC (AUC) of combined MELD score and PCT (0.880) was higher than that of only MELD score (0.820) or PCT (0.803),respectively (both P<0.001).Conclusion MELD score combined with serum PCT achieves a predictive value for the short-term prognosis in patients with HBV-related ACLF.