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不同指南诊断标准对人工肝治疗慢加急性肝衰竭患者短期预后的影响

陈宇航 姜梓萌 张志娇 郑梦瑶 王梅莲 黄华 赵公芳

引用本文:
Citation:

不同指南诊断标准对人工肝治疗慢加急性肝衰竭患者短期预后的影响

DOI: 10.3969/j.issn.1001-5256.2023.11.017
基金项目: 

云南省“万人计划”名医人才专项 (YNWR-MY-2019-074)

伦理学声明:本研究方案于2022年4月8日经由昆明医科大学第二附属医院伦理委员会审批,批号:审-PJ-科-2022-109,患者均签署知情同意书。
利益冲突声明:本研究不存在任何利益冲突。
作者贡献声明:陈宇航负责文章的构思设计、论文撰写与修订;姜梓萌、张志娇负责数据的获取及分析处理过程;郑梦瑶、王梅莲对研究的思路有贡献;黄华、赵公芳参与修改文章的关键内容。
详细信息
    通信作者:

    赵公芳, zhaogongfangedu@163.com (ORCID: 0000-0001-9178-1567)

The influence of diagnostic criteria of different guidelines on short-term prognosis of artificial liver therapy for acute-on-chronic liver failure

Research funding: 

The Yunnan Province “Million People Program” of Famous Doctors and Talents Project (YNWR-MY-2019-074)

More Information
  • 摘要:   目的  探讨不同诊断标准对慢加急性肝衰竭患者短期预后的影响。  方法  纳入2018年1月—2022年1月昆明医科大学第二附属医院消化内科住院的115例慢加急性肝衰竭患者,均采用内科联合人工肝治疗。根据指南将患者分为CMA指南组(中华医学会肝衰竭诊治指南)(n=100)、APASL指南组(亚太肝病学会共识)(n=94)和EASL指南组(欧洲肝病学会标准)(n=36),随访末次人工肝治疗后90 d生存情况。计量资料组间比较采用单因素方差分析,计数资料组间比较采用χ2检验。采用受试者工作特征曲线(ROC曲线)比较上述3个指南90 d病死率的差异以及对死亡风险的预测价值。  结果  CMA指南组90 d病死率为50.0%,APASL指南组51.1%,EASL指南组77.8%,EASL指南组90 d病死率显著高于CMA指南组(χ2=8.351,P=0.004)和APASL指南组(χ2=7.650,P=0.006);EASL指南对短期死亡风险预测的敏感度为22.2%,特异度为92.3%,对应的曲线下面积为0.576。  结论  符合EASL指南的慢加急性肝衰竭患者短期预后更差,该指南有助于识别短期死亡风险较高的患者。

     

  • 图  1  短期死亡风险的ROC曲线图

    Figure  1.  ROC curve of short-term death risk

    表  1  一般资料比较

    Table  1.   Comparison of general data

    项目 CMA指南组 (n=100) APASL指南组 (n=94) EASL指南组 (n=36) 统计值 P
    性别[例(%)] χ2=0.017 0.992
    70(70.0) 65(69.1) 25(69.4)
    30(30.0) 29(30.9) 11(30.6)
    年龄(岁) 49.9±12.3 49.5±11.8 53.5±12.2 F=1.543 0.216
    病因[例(%)] χ2=5.762 0.674
    乙型肝炎 49(49.0) 46(48.9) 12(33.3)
    丙型肝炎 2(2.0) 2(2.1) 1(2.8)
    酒精性肝病 24(24.0) 23(24.5) 9(25.0)
    自身免疫性肝病 11(11.0) 11(11.7) 4(11.1)
    其他 14(14.0) 12(12.8) 10(27.8)
    人工肝模式[例(%)] χ2=4.201 0.379
    PE 27(27.0) 30(31.9) 16(44.4)
    DPMAS 55(55.0) 45(47.9) 15(41.7)
    PE+DPMAS 18(18.0) 19(20.2) 5(13.9)
    人工肝次数(次) 3.3±1.7 3.3±1.6 2.7±1.2 F=2.137 0.120
    住院时长(d) 19.4±8.2 19.6±8.0 16.2±7.0 F=2.663 0.072
    90 d病死率[例(%)] 50(50.0)1) 48(51.1)1) 28(77.8) χ2=9.133 0.010
    注:与EASL指南组比较,1) P<0.05。
    下载: 导出CSV

    表  2  3组赋值和人数统计

    Table  2.   Assignment and population statistics of the three groups

    生存情况 赋值
    1=CMA指南组 2=APASL指南组 3=EASL指南组
    死亡(例) 50 48 28
    存活(例) 50 46 8
    合计(例) 100 94 36
    下载: 导出CSV
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  • 收稿日期:  2023-03-04
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