失代偿期肝硬化预后危险因素分析及相关预后模型比较的研究

发布时间：2018-10-10 17:13

【摘要】：【目的】研究影响失代偿期肝硬化患者预后的危险因素。比较Child-Pugh分级、终末期肝病模型（MELD评分）及MELD-Na评分、Cr-Child评分这四种肝硬化预后模型的预测价值，帮助临床医生准确判断失代偿肝硬化患者的预后转归，对临床选择有效的治疗方法具有重要的指导价值。【方法】 1.选择2010年1月至2013年12月入住我院消化科的231例确诊失代偿期肝硬化患者作为研究对象，采用回顾性随访调查研究，制定病史资料登记表，记录每例研究对象的基本情况、病史、实验室检查及影像学检查信息，采用电话随访的方式进行随访，记录研究对象3个月的事件结局。将资料录入Microsoft Excel2007forWindows，建立数据库，采用SPSS17.0for Windows软件进行统计学处理。其中定量资料使用t检验，定性资料使用卡方检验，采用单因素及多因素Logistic回归分析方法，得出相应的独立危险因素。 2.选择方法1中的临床资料作为比较Child-Pugh分级、MELD评分、MELD-Na评分、Cr-Child评分这四种预后模型的分析样本。通过计算受试者工作特征曲线（ROC）的曲线下面积（AUC），比较其预测价值。【结果】 1.单因素Logistic分析：上消化道出血、WBC、ALB、Cys C、HDL、Na、A/G是影响预后的因素，其中上消化道出血、Cys C与患者死亡风险呈正相关（P 0.05），，WBC、ALB、HDL、Na、A/G与患者死亡风险呈负相关（P 0.05），其余指标差异无统计学意义（P0.05）。 2.多因素Logistic分析影响失代偿期肝硬化预后的独立危险因素为：ALB、Na。血清ALB和Na浓度预测死亡的ROC曲线下面积分别为0.867、0.904，与0.5相比差异有统计学意义（P 0.001）。 3. MELD-Na评分、MELD评分、Child-Pugh分级、Cr-Child评分的ROC曲线下面积（AUC）分别为0.812（95%CI0.715-0.909）、0.802（95%CI0.703-0.901）、0.783（95%CI0.618-0.885）和0.732（95%CI0.621-0.843）。MELD-Na评分在预测失代偿期肝硬化患者短期预后方面明显优于Child分级、MELD评分及Cr-Child评分。【结论】血清ALB和Na浓度是影响失代偿期肝硬化短期预后的独立危险因素，血钠水平对肝硬化患者预后具有较高的预测价值。 MELD-Na评分的预测价值明显优于Child-Pugh分级、MELD评分及Cr-Child评分这三种预后模型，具有客观性、稳定性等优点，推荐临床普遍使用。
[Abstract]:Objective to study the prognostic factors of decompensated cirrhosis. To compare the predictive value of Child-Pugh grade, end-stage liver disease model (MELD), MELD-Na score and Cr-Child score in predicting the prognosis of patients with decompensated cirrhosis, and to help clinicians accurately judge the prognosis of patients with decompensated cirrhosis. It has important guiding value for clinical selection of effective treatment methods. [methods] 1. From January 2010 to December 2013, 231 patients with decompensated cirrhosis who were admitted to the Department of Digestive Medicine in our hospital were selected as the study subjects. History, laboratory and imaging information were followed up by telephone, and the outcome of 3 months was recorded. Data input into Microsoft Excel2007forWindows, to establish a database, using SPSS17.0for Windows software for statistical processing. T test was used for quantitative data, chi-square test was used for qualitative data, and independent risk factors were obtained by single factor and multivariate Logistic regression analysis. 2. The clinical data in method 1 were selected as the analysis samples of four prognostic models: Child-Pugh grade, MELD score, MELD-Na score and Cr-Child score. The area under the curve of the operating characteristic curve (ROC) was calculated to compare its predictive value. [results] 1. Univariate Logistic analysis showed that upper gastrointestinal hemorrhage and WBC,ALB,Cys HDL Logistic / A / G were the prognostic factors. There was a positive correlation between, Cys C and death risk in patients with upper gastrointestinal hemorrhage (P 0.05), a negative correlation between WBC,ALB,HDL,Na,A/G and death risk (P 0.05), and no significant difference in other indexes (P0.05). The independent risk factors for the prognosis of decompensated cirrhosis by multivariate Logistic analysis were as follows: ALB,Na. The area under the ROC curve of serum ALB and Na was 0.8670.904, which was significantly higher than that of Na (P 0.001). The area under ROC curve of MELD-Na score, MELD score, Child-Pugh grade and Cr-Child score were 0.812 (95%CI0.715-0.909), 0.802 (95%CI0.703-0.901), 0.783 (95%CI0.618-0.885) and 0.732 (95%CI0.621-0.843) respectively. MELD-Na score was superior to Child grade, MELD score and Cr-Child score in predicting short-term prognosis of decompensated cirrhosis patients. [conclusion] Serum ALB and Na levels are independent risk factors for short-term prognosis of decompensated cirrhosis. The value of MELD-Na score is better than that of Child-Pugh grade, MELD score and Cr-Child score, which has the advantages of objectivity and stability. General clinical use is recommended.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575.2

【参考文献】