摘要
目的 探讨更新的中国重型乙型肝炎研究小组评分(Chinese Group on the Study of Severe Hepatitis B, COSSH)短期动态变化对乙型肝炎相关慢加急性肝衰竭(hepatitis B virus-related acute-on-chronic liver failure, HBV-ACLF)患者的临床意义。方法 采用回顾性队列研究方法,选取兰州市第二人民医院2017年1月至2021年7月收治的99例HBV-ACLF患者,记录其一般特征、48小时和3~7天实验室检查指标,以及28天和90天预后,并分别计算入院时、48小时、3~7天的COSSH-ACLFⅡs评分。采用受试者工作特征(ROC)曲线和曲线下面积(AUC)评价各评分模型对患者短期预后的预测价值;采用分类变量分析HBV-ACLF患者COSSH-ACLFⅡs短期动态变化的临床预测价值。结果 COSSH-ACLFⅡs预测患者28天和90天病死率,最大AUC的敏感性和特异性最高,分别为75%/84%和86.8%/80.9%。35.86%的患者病情缓解或改善,42.4%病程稳定或波动,21.7%病情恶化。改善组患者生存率为87.8%,恶化组患者病死率为85.0%。结论 与终末期肝病模型(model for end-stage liver disease, MELD)评分、MELD-血清钠(MELD-Na)评分、器官功能衰竭评分(CLIF consortium organ failure score, CLIF-COFs)、CLIF-CACLF评分(CLIF-consortium ACLF score, CLIF-C ACLFs)相比,COSSH-ACLFⅡs对HBV-ACLF具有更高的敏感性和特异性。COSSH-ACLFⅡs可准确预测3~7天生存率。
Objective To investigate the clinical significance of the short-term dynamic changes of the new COSSH score(COSSH-ACLFⅡs)in patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).Methods This is a retrospective cohort study with 99 HBV-ACLF patients who were admitted in Lanzhou Second People's Hospital.,The general characteristics,48hr,3~7 d laboratory examination index,28 d and 90 d prognosis were recorded,and the prognosis score at admission,48 hr and 3~7 d COSSH-ACLFⅡs score were calculated,respectively.The receiver operating characteristic(ROC)curve and the area under the curve(AUC)were used to evaluate the predictive value of each scoring model on the short-term prognosis of the studied patients.The clinical predictive value of the short-term dynamic changes of COSSH-ACLFⅡs in HBV-ACLF was analyzed by classified variables.Results The largest AUC of COSSH-ACLFIIs to predict the 28d and 90d deaths of patients had the highest sensitivity and specificity(75%vs.84%and 86.8%vs.80.9%,respectively).The COSSH-ACLFIIs resolved or improved in 35.86%of patients,had a steady or fluctuating course in 42.4%and worsened in 21.7%of patients.In the improvement group,87.8%of patients survived,while in the deterioration group,85.0%of patients died.Conclusion In comparison with MELD,MELD-Na,CLIF-COFs,and CLIF-CACLFs,COSSH-ACLFIIs has higher sensitivity and specificity for predicting HBV-ACLF.The Survival of 3~7d can be accurately predicted after evaluation with COSSH-ACLFIIs.
作者
刘玉盒
张樱
李斌华
谢青
陈小勇
闫雪华
LIU Yu-he;ZHANG Ying;LI Bin-hua;XIE Qing;CHEN Xiao-yong;YAN Xue-hua(The Second People’s Hospital of Lanzhou City,Gansu 730030,China)
出处
《肝脏》
2025年第6期796-800,共5页
Chinese Hepatology
关键词
慢加急性肝衰竭
预测模型
动态变化
回顾性队列研究
Acute-on-chronic liver failure
Prediction model
Dynamic change
Retrospective cohort study
