PCT与Child-Pugh评分对乙肝相关慢加急性肝衰竭预后的评估价值

目的:探讨降钙素原(PCT)与Child-Pugh评分对乙肝相关慢加急性肝衰竭预后评估的价值。方法:对113例乙肝相关慢加急性肝衰竭患者的生存率进行回顾性分析,根据患者入院当天的检查指标计算Child-Pugh评分并统计降钙素原数值,以受试者工作曲线(ROC)下的面积来评价两者预测预后的能力,同时进行二者的相关性分析。结果:Child-Pugh评分与降钙素原呈显著相关(r=0.64,P<0.01)。113例患者中死亡29例,死亡组Child-Pugh评分及降钙素原值均高于生存组(P<0.01);根据ROC曲线Child-Pugh评分截断值为11.00,敏感度69%,特异性73%;降钙素原截断值为2.66,敏感度为58%,特异性为67%;二者联合应用则敏感度及特异性可分别提高至89%和77%。结论:Child-Pugh评分及降钙素原对乙肝相关慢加急性肝衰竭的预后均可做出有效的预测,二者联用可以提高预测准确度。

Prognostic value of PCT and Child-Pugh score in patients with HBV-related acute-on-chronic liver failure

Objective： To assess the prognostic value of PCT and the Child-Pugh score in patients with HBV-related acute-on-chronic liver failure,and to evaluate the relationship between PCT and the Child-Pugh score. Methods： The value of PCT and Child-Pugh score of 113 patients with HBV-related acute-on-chronic liver failure were retrospectively calculated. Using Receiver operating characteristic curves to determine PCT and the Child-Pugh score cut-offs with the best sensitivity（ SS） and specificity（ SP） in discriminating between patients who survived and those who died.Results： PCT and Child-Pugh score showed significant correlation（ r = 0. 64,P〈0. 01）. Among the 113 patients PCT and Child-Pugh score of the 29 patients who died were significantly higher than those who survived. According to the ROC curves a Child-Pugh score cut-off of 11. 00 had69% SS and 73% SP,whereas a PCT cut-off of 2. 66 had 58% SS and 67% SP in discriminating between patients who survived and those who died. The combined assessment of PCT and ChildPugh score had 89% SS and 77% SP. Conclusion： In patients with HBV-related acute-on-chronic liver failure,the PCT has prognostic capability that is not significantly different from that of ChildPugh score. Combined assessment of the two parameters increases the prognostic accuracy.