重症化慢性乙型肝炎患者进展为肝衰竭的危险因素及四种预测模型的比较

发布时间：2018-05-04 02:01

  本文选题：重症化 + 慢性乙型肝炎　； 参考：《遵义医学院》2017年硕士论文

【摘要】：目的:研究重症化慢性乙型肝炎(chronic hepatitis B,CHB)患者进展为肝衰竭的危险因素及比较四种预测模型的应用价值。方法:回顾性分析2011年1月至2017年2月我遵义医学院附属医院感染科住院部收治的474例重症化CHB患者临床资料;采用SPSS19.0软件进行统计分析,找出与重症化CHB患者进展为ACLF相关的危险因素;分别计算MELD评分、MELD-Na评分、Gao Fangyuan等建立的预测模型(DT模型)和张绪清等建立的预测模型(SJY模型)评分分值,比较其分值大小与重症化CHB患者中ACLF发生率的关系,用工作特征(receiver operating characteristic,ROC)曲线及曲线下面积(area under the curve,AUC)评估四种评分模型的预测价值。结果:1.共筛选出符合标准的重症化CHB患者474例,其中进展为ACLF 36例(ACLF组),未进展为ACLF患者438例(non-ACLF组),通过对比两组患者的临床指标,发现年龄≥40岁、HBV DNA≥107拷贝/ml、血钠(sodium,Na~+)、血清总胆红素(total bilirubin,TBIL)、凝血酶原活动度(prothrombin activity,PTA)和国际标准化比值(international normalized ratio,INR)共6个因素差异有统计学意义(P0.05),提示重症化CHB患者进展为ACLF与上述因素有关;2.MELD评分、MELD-Na评分、DT模型评分和SJY模型评分的分值大小与ACLF发生率均呈正相关关系,其结果有显著统计学差异(P0.05);3.SJY预测模型AUC最大为0.84,其次为DT预测模型(0.79),明显高于MELD(0.70)及MELD-Na(0.69)。SJY模型具有较高的的敏感性(0.86)和特异性(0.75)。结论:重症化CHB患者进展为ACLF的危险因素包括年龄≥40岁,HBV DNA≥107拷贝/ml,Na~+、TBIL、PTA和INR;MELD评分、MELD-Na评分、DT预测模型和SJY预测模型评分的分值大小与ACLF发生率均呈正相关关系;DT模型和SJY模型对重症化CHB患者进展为ACLF都具有较好的预测作用,优于MELD及MELD-Na评分模型。
[Abstract]:Objective: to study the risk factors of progression to liver failure in patients with severe chronic hepatitis B (CHB) and to compare the application value of four predictive models. Methods: the clinical data of 474 patients with severe CHB were analyzed retrospectively from January 2011 to February 2017 in the Department of infection, affiliated Hospital of Zunyi Medical College, and were statistically analyzed by SPSS19.0 software. To find out the risk factors related to the progression of severe CHB patients to ACLF, to calculate the MELD score and the prediction model established by MELD-Na, Gao Fangyuan et al.) and to calculate the score value of SJY model, which were established by Zhang Xuqing, et al. The relationship between the score and the incidence of ACLF in severe CHB patients was compared. The predictive value of the four scoring models was evaluated by using the receiver operating characteristic roc curve and the area under the curve. The result is 1: 1. A total of 474 severe CHB patients who met the criteria were selected, including 36 patients with ACLF and 438 patients with non-ACLF who did not progress to ACLF. The clinical indexes of the two groups were compared. It was found that there were significant differences in six factors, including age 鈮，

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