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HBV相关慢加急性肝衰竭预后简易评分系统的建立
A simple scoring system for evaluating severity of HBV-related acute-on-chronic liver failure
文章发布日期:2014年09月12日  来源:  作者:厉新妍,黄淑琳,方亮,等  点击次数:2414次  下载次数:566次

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【摘要】:目的建立HBV相关慢加急性肝衰竭(HBV-ACLF)严重度简易评分系统。 方法收集620例HBV-ACLF患者的临床资料,选择肝性脑病、血清肌酐、血清总胆红素、凝血酶原活动度、感染、肝脏大小、腹水液平等7个临床指标,应用统计学方法并结合临床实际,确定各指标从0~4分评分界点,并累计总分。据此建立模型并确定诊断界点,对此评分模型进行验证。 结果 对HBV-ACLF患者临床资料进行统计学分析,交互卡方检验确定各指标评分分值并建立模型。将500例患者分为生存组和死亡组。两组间评分差异有统计学意义(t=25.78,P<0.001)。受试者工作特征曲线(ROC曲线)下面积0.963,最佳临界值9.5,灵敏度098,特异度0.83。120例患者对其进行验证,≥10分预后差,病死率为84.3%,≤9分组预后好,病死率为3.5%。两组病死率比较差异有统计学意义(χ2=72.2,P<0.001)。结论本评分系统可用于HBV-ACLF预后评估,具有简易、敏感、客观的优点。
【Abstract】:ObjectiveTo establish a simple scoring system for evaluating the severity of hepatitis B virus (HBV)-related acute-on-chronic liver failure (HBV-ACLF). MethodsA retrospective analysis was performed on the clinical data of 620 patients with HBV-ACLF who were divided into group I (500 patients) and group II (120 patients). Seven clinical parameters, including hepatic encephalopathy, serum creatinine, prothrombin activity, serum total bilirubin, infection, dimension of liver, and maximum depth of ascites, were scored from 0-4 points for each patient according to the disease severity. The severity scoring system was established based on the total score of each patient in group I, with the cut-off point being determined. The established system was tested with group II. ResultsA severity scoring system was successfully developed based on chi-squared automatic interaction detector analysis of the total score of each patient in group I. There was a significant difference in the total score between the survival and death subgroups of the 500 patients (t=25.78, P<0001). The area under the ROC curve was 0.963, suggesting a high validity of this scoring system. With the cut-off value of 9.5, the sensitivity and specificity of this system were 0.98 and 0.83, respectively. The other 120 patients were divided into the poor prognosis (score ≥10) and good prognosis subgroups (score ≤9) based on the scoring system, with the mortality rates being 84.3% and 3.5%, respectively; there was a significant difference in mortality between the two subgroups (χ2=72.2, P<0.001). ConclusionThis scoring system is simple, sensitive, and objective to evaluate the severity of HBV-ACLF.
【关键字】:肝炎病毒,乙型;肝功能衰竭;预后
【Key words】:hepatitis B virus; liver failure; prognosis
【引证本文】:

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