经血浆置换治疗乙肝相关慢加急性肝衰竭患者短期预后模型的研究(1)
[摘要] 目的 建立經血浆置换(PE)治疗乙肝相关慢加急性肝衰竭(HBV-ACLF)患者预后判断模型。 方法 回顾性分析广西医科大学第一附属医院2012年1月～2017年10月收治的138例经PE治疗的HBV-ACLF患者资料，根据PE治疗后12周存活情况分为生存组与死亡组，采用 Logistic 回归分析可能影响预后的因素并建立回归模型，使用ROC曲线下面积(AUC)评价模型的预测价值。 结果 生存组56例，死亡组82例。单因素分析显示年龄、总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、甘油三酯(TG)、肝性脑病(HE)、肝肾综合征(HRS)、MELD评分、Child-Turcotte-Pugh(CTP)评分9个因素在两组间差异有统计学意义(P<0.05)。经Logistic 回归分析筛选出年龄、TBIL、AST、肝性脑病、肝肾综合征5个因素用于回归模型的拟合。模型的ROC曲线下面积为0.879(95%CI：0.822-0.936)，灵敏度为75.61%，特异度为85.71%。模型与CTP评分、MELD评分的AUC对比差异无统计学意义(P>0.05)。 结论 研究中拟合的Logistic回归模型对预后评估有一定参考价值，与CTP评分、MELD评分有同等预后判断价值。
[关键词] 血浆置换;慢性乙型肝炎;慢加急性肝衰竭;预后模型
[中图分类号] R575.1 [文献标识码] A [文章编号] 1673-9701(2019)05-0027-04
[Abstract] Objective To establish a prognostic model for patients with hepatitis B-related acute-on-chronic liver failure(HBV-ACLF)treated with plasma exchange(PE). Methods A retrospective analysis of 138 patients with PE-treated HBV-ACLF who were admitted to the First Affiliated Hospital of Guangxi Medical University from January 2012 to October 2017 was performed. According to the survival of 12 weeks after PE treatment， the patients were divided into the survival group and the death group. Logistic regression was used to analyze factors that might affect prognosis to establish a regression model. The area under the ROC curve(AUC) was used to evaluate the predicted value of the model. Results There were 56 patients in the survival group and 82 patients in the death group. Univariate analysis showed that there were 9 factors with statistically significant differences between the two groups(P<0.05)， namely： Age， total bilirubin(TBIL)， alanine aminotransferase(ALT)， aspartate aminotransferase(AST)， triglyceride(TG)， hepatic encephalopathy(HE)， hepatorenal syndrome(HRS)， MELD score， and Child-Turcotte-Pugh(CTP)score. Logistic regression analysis screened five factors including age， TBIL， AST， hepatic encephalopathy， and hepatorenal syndrome for regression model fitting. The area under the ROC curve of the model was 0.879(95% CI： 0.822-0.936)， the sensitivity was 75.61%， and the specificity was 85.71%. There was no significant difference between the AUC of the model and the AUC of CTP score and MELD score(P>0.05). Conclusion The logistic regression model fitted in the study has certain reference value for prognosis evaluation， and has the same prognostic value as CTP score and MELD score.
[Key words] Plasma exchange; Chronic hepatitis B; Acute-on-chronic liver failure; Prognosis model, http://www.100md.com(甘琼萍 谭可平 陈婵 等)
[关键词] 血浆置换;慢性乙型肝炎;慢加急性肝衰竭;预后模型
[中图分类号] R575.1 [文献标识码] A [文章编号] 1673-9701(2019)05-0027-04
[Abstract] Objective To establish a prognostic model for patients with hepatitis B-related acute-on-chronic liver failure(HBV-ACLF)treated with plasma exchange(PE). Methods A retrospective analysis of 138 patients with PE-treated HBV-ACLF who were admitted to the First Affiliated Hospital of Guangxi Medical University from January 2012 to October 2017 was performed. According to the survival of 12 weeks after PE treatment， the patients were divided into the survival group and the death group. Logistic regression was used to analyze factors that might affect prognosis to establish a regression model. The area under the ROC curve(AUC) was used to evaluate the predicted value of the model. Results There were 56 patients in the survival group and 82 patients in the death group. Univariate analysis showed that there were 9 factors with statistically significant differences between the two groups(P<0.05)， namely： Age， total bilirubin(TBIL)， alanine aminotransferase(ALT)， aspartate aminotransferase(AST)， triglyceride(TG)， hepatic encephalopathy(HE)， hepatorenal syndrome(HRS)， MELD score， and Child-Turcotte-Pugh(CTP)score. Logistic regression analysis screened five factors including age， TBIL， AST， hepatic encephalopathy， and hepatorenal syndrome for regression model fitting. The area under the ROC curve of the model was 0.879(95% CI： 0.822-0.936)， the sensitivity was 75.61%， and the specificity was 85.71%. There was no significant difference between the AUC of the model and the AUC of CTP score and MELD score(P>0.05). Conclusion The logistic regression model fitted in the study has certain reference value for prognosis evaluation， and has the same prognostic value as CTP score and MELD score.
[Key words] Plasma exchange; Chronic hepatitis B; Acute-on-chronic liver failure; Prognosis model, http://www.100md.com(甘琼萍 谭可平 陈婵 等)