中文English
ISSN 1001-5256
CN 22-1108/R

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

凝血酶原国际标准化比值/白蛋白对失代偿期肝硬化患者预后的预测价值

孟淑慧 胥莹 邹松龙 张雪 吴杰芳

孟淑慧,胥莹,邹松龙,等. 凝血酶原国际标准化比值/白蛋白对失代偿期肝硬化患者预后的预测价值[J]. 临床肝胆病杂志, 2021, 37(9): 2081-2086. DOI: 10.3969/j.issn.1001-5256.2021.09.016
引用本文: 孟淑慧,胥莹,邹松龙,等. 凝血酶原国际标准化比值/白蛋白对失代偿期肝硬化患者预后的预测价值[J]. 临床肝胆病杂志, 2021, 37(9): 2081-2086. DOI: 10.3969/j.issn.1001-5256.2021.09.016
MENG SH, XU Y, ZOU SL, et al. Value of prothrombin time-international normalized ratio to albumin ratio in predicting the prognosis of patients with decompensated cirrhosis[J]. J Clin Hepatol, 2021, 37(9): 2081-2086. DOI: 10.3969/j.issn.1001-5256.2021.09.016
Citation: MENG SH, XU Y, ZOU SL, et al. Value of prothrombin time-international normalized ratio to albumin ratio in predicting the prognosis of patients with decompensated cirrhosis[J]. J Clin Hepatol, 2021, 37(9): 2081-2086. DOI: 10.3969/j.issn.1001-5256.2021.09.016

凝血酶原国际标准化比值/白蛋白对失代偿期肝硬化患者预后的预测价值

DOI: 10.3969/j.issn.1001-5256.2021.09.016
详细信息
    通讯作者:

    胥莹,xuying_0505@163.com

  • 中图分类号: R575.2

Value of prothrombin time-international normalized ratio to albumin ratio in predicting the prognosis of patients with decompensated cirrhosis

  • 摘要:   目的  探讨凝血酶原国际标准化比值/白蛋白(PTAR)评估失代偿期肝硬化患者预后的临床价值。  方法  回顾性分析2016年4月—2017年4月昆明医科大学第二附属医院收治的172例失代偿期肝硬化患者的临床资料,包括性别、年龄、病因、并发症、入院后首次的实验室指标检测等。以死亡为终点事件,根据随访2年的疾病转归情况将所纳入患者分为生存组(n=98)和死亡组(n=74)。分析影响预后的相关因素,并评估PTAR对失代偿期肝硬化患者预后的预测价值。计量资料两组间比较采用t检验或Mann-Whitney U检验。计数资料两组间比较采用χ2检验或Fisher确切概率法。对相关变量行单因素和多因素Cox回归分析。绘制受试者工作特征曲线(ROC曲线),计算曲线下面积(AUC),并根据ROC曲线的敏感度和特异度确定最佳临界值。运用Kaplan-Meier生存曲线分析不同PTAR、吲哚菁绿15 min滞留率(ICGR15)、MELD评分患者的2年生存率,并采用log-rank检验比较组间差异。  结果  死亡组患者的PTAR(Z=-7.823,P<0.001)、ICGR15(t=3.458,P=0.001)及MELD评分(t=5.921,P<0.001)均明显高于生存组。PTAR、ICGR15、MELD评分预测患者2年预后的最佳临界值分别为0.05、41.00%、37.25分,AUC分别为0.849、0.651、0.724。生存分析提示高水平PTAR组(PTAR≥0.05)患者生存率显著低于低水平PTAR组(PTAR<0.05)(χ2=60.07,P<0.001)。多因素Cox回归分析结果显示,PTAR≥0.05是患者2年死亡的独立危险因素(HR=2.564,95%CI:1.276~5.151,P=0.008)。  结论  PTAR≥0.05可作为失代偿期肝硬化患者2年死亡的独立预测因子,PTAR对失代偿肝硬化患者预后有较高的预测价值。

     

  • 图  1  3种指标预测失代偿期肝硬化患者2年死亡的ROC曲线

    图  2  不同PTAR、ICGR15、MELD评分患者的Kaplan-Meier生存曲线

    表  1  纳入研究的两组患者临床基线特征比较

    指标 死亡组(n=74) 生存组(n=98) 统计值 P
    年龄(岁) 54.81±13.64 50.51±12.44 t=2.154 0.033
    男/女(例) 58/16 66/32 χ2=2.550 0.110
    Alb(g/L) 26.48±4.28 33.39±5.35 t=-9.126 <0.001
    ALT(U/L) 49.50(26.00~134.25) 36.00(20.50~70.00) Z=-2.787 0.005
    AST(U/L) 94.00(52.75~260.75) 52.00(34.50~79.00) Z=-4.776 <0.001
    GGT(U/L) 94.50(41.50~201.25) 73.00(33.50~133.00) Z=-1.761 0.078
    ALP(U/L) 156.50(109.75~233.75) 121.00(92.50~157.00) Z=-3.257 0.001
    TBil(μmol/L) 152.15(56.45~331.40) 74.10(35.50~160.40) Z=-3.906 <0.001
    SCr(μmol/L) 74.50(61.00~90.50) 68.00(53.50~77.50) Z=-2.479 0.013
    TC(mol/L) 2.33(1.76~3.60) 3.33(2.38~4.27) Z=-3.345 0.001
    Na(mol/L) 137.70(133.38~139.35) 139.00(137.95~140.90) Z=-3.221 0.001
    PT(s) 19.70(17.05~24.83) 15.70(13.95~17.35) Z=-6.183 <0.001
    INR 1.80(1.42~2.26) 1.28(1.15~1.54) Z=-6.201 <0.001
    WBC(×109/L) 6.09(3.65~7.98) 4.74(3.36~7.33) Z=-1.553 0.121
    Hb(g/L) 109.36±25.87 117.66±25.26 t=-2.111 0.036
    中性粒细胞计数(×109/L) 4.43(2.10~5.64) 2.79(2.05~4.97) Z=-1.803 0.071
    PTAR 0.06(0.05~0.09) 0.04(0.03~0.05) Z=-7.823 <0.001
    ICGR15(%) 47.58±16.86 37.96±18.91 t=3.458 0.001
    MELD评分(分) 38.15±9.04 31.11±6.56 t=5.921 <0.001
    静脉曲张[例(%)] 47(63.5) 67(68.4) χ2=0.444 0.505
    静脉曲张破裂出血[例(%)] 28(37.8) 19(19.4) χ2=7.227 0.007
    肝性脑病[例(%)] 14(18.9) 9(9.2) χ2=3.450 0.063
    腹腔积液[例(%)] 62(83.8) 49(50.0) χ2=21.026 <0.001
    细菌感染[例(%)] 34(45.9) 41(41.8) χ2=0.290 0.591
    肝肾综合征[例(%)] 3(4.1) 2(2.0) 0.653
    下载: 导出CSV

    表  2  3种指标预测失代偿期肝硬化患者2年内死亡的诊断效能比较

    指标 AUC 95% CI 敏感度 特异度 最佳临界值 约登指数
    PTAR 0.849 0.791~0.906 0.797 0.786 0.05 0.583
    ICGR15 0.651 0.569~0.733 0.770 0.561 41.00% 0.331
    MELD评分 0.724 0.646~0.802 0.568 0.827 37.25分 0.395
    三者联合 0.851 0.795~0.907 0.784 0.796 0.41 0.580
    下载: 导出CSV

    表  3  单因素及多因素Cox回归分析

    指标 单因素分析 多因素分析
    B P HR 95%CI B P HR 95%CI
    年龄 0.019 0.051 1.019 1.000~1.039
    ICGR15 0.021 0.001 1.021 1.009~1.034
    MELD评分 0.070 <0.001 1.073 1.047~1.099
    Hb -0.010 0.044 0.990 0.981~1.000
    Alb -0.177 <0.001 0.838 0.799~0.878 -0.121 <0.001 0.886 0.835~0.939
    PTAR≥0.05 1.923 <0.001 6.839 3.861~12.114 0.941 0.008 2.564 1.276~5.151
    ALT 0.002 <0.001 1.002 1.001~1.002
    AST 0.002 <0.001 1.002 1.001~1.003 0.001 <0.001 1.001 1.001~1.002
    ALP 0.001 0.020 1.001 1.000~1.001
    TBil 0.004 <0.001 1.004 1.002~1.005
    SCr 0.002 0.082 1.002 1.000~1.004
    TC -0.210 0.025 0.811 0.675~0.974
    PT 0.096 <0.001 1.101 1.070~1.132
    INR 0.813 <0.001 2.255 1.768~2.876
    静脉曲张破裂出血 0.623 0.009 1.865 1.165~2.984
    腹腔积液 1.301 <0.001 3.647 1.977~6.829
    下载: 导出CSV
  • [1] European Association for the Study of the Liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis[J]. J Hepatol, 2018, 69(2): 406-460. DOI: 10.1016/j.jhep.2018.03.024.
    [2] BERNARDI M, CARACENI P. Novel perspectives in the management of decompensated cirrhosis[J]. Nat Rev Gastroenterol Hepatol, 2018, 15(12): 753-764. DOI: 10.1038/s41575-018-0045-2.
    [3] KOKUDO T, HASEGAWA K, AMIKURA K, et al. Assessment of preoperative liver function in patients with hepatocellular carcinoma-the Albumin-Indocyanine Green Evaluation (ALICE) grade[J]. PLoS One, 2016, 11(7): e0159530. DOI: 10.1371/journal.pone.0159530.
    [4] WANG YY, ZHAO XH, MA L, et al. Comparison of the ability of Child-Pugh score, MELD score, and ICG-R15 to assess preoperative hepatic functional reserve in patients with hepatocellular carcinoma[J]. J Surg Oncol, 2018, 118(3): 440-445. DOI: 10.1002/jso.25184.
    [5] CHENG XP, ZHAO J, CHEN Y, et al. Comparison of the ability of the PDD-ICG clearance test, CTP, MELD, and MELD-Na to predict short-term and medium-term mortality in patients with decompensated hepatitis B cirrhosis[J]. Eur J Gastroenterol Hepatol, 2016, 28(4): 444-448. DOI: 10.1097/MEG.0000000000000538.
    [6] HARUKI K, SHIBA H, SAITO N, et al. Risk stratification using a novel liver functional reserve score of combination prothrombin time-international normalized ratio to albumin ratio and albumin in patients with hepatocellular carcinoma[J]. Surgery, 2018, 164(3): 404-410. DOI: 10.1016/j.surg.2018.02.022.
    [7] GAO F, CAI MX, LIN MT, et al. Prognostic value of international normalized ratio to albumin ratio among critically ill patients with cirrhosis[J]. Eur J Gastroenterol Hepatol, 2019, 31(7): 824-831. DOI: 10.1097/MEG.0000000000001339.
    [8] Chinese Society of Hepatology, Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.

    中华医学会肝病学分会. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.
    [9] SHAH AS, AMARAPURKAR DN. Natural history of cirrhosis of liver after first decompensation: A prospective study in India[J]. J Clin Exp Hepatol, 2018, 8(1): 50-57. DOI: 10.1016/j.jceh.2017.06.001.
    [10] DURAND F, VALLA D. Assessment of the prognosis of cirrhosis: Child-Pugh versus MELD[J]. J Hepatol, 2005, 42(Suppl 1): s100-s107. DOI: 10.1016/j.jhep.2004.11.015.
    [11] KAMATH PS, WIESNER RH, MALINCHOC M, et al. A model to predict survival in patients with end-stage liver disease[J]. Hepatology, 2001, 33(2): 464-470. DOI: 10.1053/jhep.2001.22172.
    [12] WIESNER R, EDWARDS E, FREEMAN R, et al. Model for end-stage liver disease (MELD) and allocation of donor livers[J]. Gastroenterology, 2003, 124(1): 91-96. DOI: 10.1053/gast.2003.50016.
    [13] ZHAI YZ, YUE YY, DING DP, et al. The value of serum prealbumin combined with MELD score in predicting the prognosis of patients with decompensated cirrhosis[J]. Chin J Hepatol, 2017, 25(7): 533-535. DOI: 10.3760/cma.j.issn.1007-3418.2017.07.012.

    翟永贞, 岳阳阳, 丁德平, 等. 血清前白蛋白联合终末期肝病模型评分评估失代偿期肝硬化患者预后的临床价值[J]. 中华肝脏病杂志, 2017, 25(7): 533-535. DOI: 10.3760/cma.j.issn.1007-3418.2017.07.012.
    [14] JIANG M, LIU F, XIONG WJ, et al. Combined MELD and blood lipid level in evaluating the prognosis of decompensated cirrhosis[J]. World J Gastroenterol, 2010, 16(11): 1397-1401. DOI: 10.3748/wjg.v16.i11.1397.
    [15] DU HL, HE HY, XIAO CJ, et al. Value of indocyanine green clearance test in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure[J]. J Clin Hepatol, 2019, 35(12): 2759-2764. DOI: 10.3969/j.issn.1001-5256.2019.12.024.

    都泓莲, 何鸿雁, 肖慈君, 等. 吲哚菁绿清除试验对HBV相关慢加急性肝衰竭患者短期预后的评估[J]. 临床肝胆病杂志, 2019, 35(12): 2759-2764. DOI: 10.3969/j.issn.1001-5256.2019.12.024.
    [16] QIN H, WAN H, WU XQ, et al. Indocyanine green clearance test assessment of liver reserve function and estimation of prognosis in patients with cirrhosis and liver failure[J]. Chin J Hepatol, 2015, 23(7): 540-542. DOI: 10.3760/cma.j.issn.1007-3418.2015.07.015.

    秦华, 万红, 吴晓庆, 等. 吲哚菁绿清除试验对肝硬化及肝衰竭患者肝脏储备功能的评估及预后的判断[J]. 中华肝脏病杂志, 2015, 23(7): 540-542. DOI: 10.3760/cma.j.issn.1007-3418.2015.07.015.
    [17] STAUBER RE, WAGNER D, STADLBAUER V, et al. Evaluation of indocyanine green clearance and model for end-stage liver disease for estimation of short-term prognosis in decompensated cirrhosis[J]. Liver Int, 2009, 29(10): 1516-1520. DOI: 10.1111/j.1478-3231.2009.02104.x.
    [18] STOCKMANN M, MALINOWSKI M, LOCK JF, et al. Factors influencing the indocyanine green (ICG) test: Additional impact of acute cholestasis[J]. Hepatogastroenterology, 2009, 56(91-92): 734-738.
    [19] IMAMURA H, SANO K, SUGAWARA Y, et al. Assessment of hepatic reserve for indication of hepatic resection: Decision tree incorporating indocyanine green test[J]. J Hepatobiliary Pancreat Surg, 2005, 12(1): 16-22. DOI: 10.1007/s00534-004-0965-9.
    [20] LONGHEVAL G, VEREERSTRAETEN P, THIRY P, et al. Predictive models of short- and long-term survival in patients with nonbiliary cirrhosis[J]. Liver Transpl, 2003, 9(3): 260-267. DOI: 10.1053/jlts.2003.50049.
    [21] KANG N, QI LC, YUAN Y, et al. Clinical significance of PTAR, Child-Pugh and MELD score in predicting the occurence of acute-on-chronic liver failure in patients with cirrhosis[J]. Chin J Gastroenterol Hepatol, 2020, 29(10): 1171-1178. DOI: 10.3969/j.issn.1006-5709.2020.10.019.

    康宁, 齐丽翠, 袁岳, 等. PTAR联合Child-Pugh及MELD评分对肝硬化患者发生慢加急性肝衰竭预测价值研究[J]. 胃肠病学和肝病学杂志, 2020, 29(10): 1171-1178. DOI: 10.3969/j.issn.1006-5709.2020.10.019.
    [22] KANG N, WANG CK, QI LC, et al. Clinical significance of PTAR and ICGR15 joint score in predicting the occurrence of acute-on-chronic liver failure in patients with hepatitis B cirrhosis[J]. Chin J Pract Intern Med, 2020, 40(7): 558-562. DOI: 10.19538/j.nk2020070108.

    康宁, 王存凯, 齐丽翠, 等. PTAR联合ICGR15对乙肝肝硬化患者发生慢加急性肝衰竭的预测价值研究[J]. 中国实用内科杂志, 2020, 40(7): 558-562. DOI: 10.19538/j.nk2020070108.
  • 加载中
图(2) / 表(3)
计量
  • 文章访问数:  51
  • HTML全文浏览量:  6
  • PDF下载量:  16
  • 被引次数: 0
出版历程
  • 收稿日期:  2021-01-12
  • 修回日期:  2021-01-27
  • 分享
  • 用微信扫码二维码

    分享至好友和朋友圈

目录

    /

    返回文章
    返回