血清CHE联合MELD评分评估肝硬化患者预后的价值

发布时间：2019-06-19 13:57

【摘要】：目的:1.了解血清胆碱酯酶(Cholinesterase,CHE)对肝损害及肝脏储备功能的评价作用;2.了解血清胆碱酯酶与终末期肝病模型(Model for end-stage of liver disease,MELD)之间的相关性;3.分析血清胆碱酯酶、终末期肝病模型评分对乙肝肝硬化失代偿期患者短期预后的预测价值。方法:1.收集2015年11月至2016年7月期间入住江苏省苏北人民医院肝脾内科病历资料和随访结果完整的失代偿期乙肝肝硬化患者80例,分析其血清CHE水平,并与30例健康体检者的血清CHE水平进行对比研究。2.分析80例失代偿期乙肝肝硬化患者CHE水平与MELD评分的相关性。3.对80例患者进行预后随访研究,根据随访3个月的存活情况分为存活组和死亡组,通过绘制血清胆碱酯酶及MELD评分系统3个月预后的受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)评价血清CHE、MELD评分对失代偿期乙肝肝硬化患者3个月预后的预测能力。4.利用ROC曲线截断值建立Kaplan-Meier生存曲线,同时分析血清CHE联合MELD评分对患者预后评估的价值。结果:1.失代偿期乙肝肝硬化患者组血清CHE值平均为(3.23±1.73)KU/L,较正常对照组(5.64±2.13)KU/L 明显降低(P0.01)。2.失代偿期乙肝肝硬化患者随着MELD评分升高,胆碱酯酶水平降低,经过pearson相关分析可知,r=-0.423,P=0.00,MELD评分与血清CHE呈明显的负相关。3.根据ROC曲线可知,CHE、MELD的截断值分别为2.09KU/L、28.5,使用MELD评分≥28.5来判断乙肝肝硬化失代偿期患者的3个月是否出现死亡的灵敏度和特异度分别为100%和82.6%,使用血清CHE值≤2.09来判断乙肝肝硬化失代偿期患者的3个月是否出现死亡的灵敏度和特异度分别为81.8%和85.5%,两种判断方法均有良好的灵敏度、特异度。4.通过截断值MELD=28.5以及CHE=2.09为界限,将80例患者分为四组,建立Kaplan-Meier生存曲线,结果显示第四组人群即MELD评分≥28.5且CHE≤2.09KU/L的乙肝肝硬化失代偿期患者死亡风险最大。结论:1.患者组的血清胆碱酯酶明显低于健康者组,血清胆碱酯酶是反映肝脏损害理想的指标。2.血清胆碱酯酶与MELD评分呈负相关,血清胆碱酯酶能够准确的反映肝功能储备功能及肝脏损害程度。3.综合MELD评分、血清CHE值更能准确判断乙肝肝硬化失代偿期患者短期预后,为患者个体化治疗方案提供临床依据,为建立新型终末期肝病模型提供思路。
[Abstract]:Objective: 1. To investigate the effect of serum cholinesterase (Cholinesterase,CHE) on liver damage and liver reserve function. To investigate the correlation between serum cholinesterase and end-stage liver disease model (Model for end-stage of liver disease,MELD. To analyze the predictive value of serum cholinesterase and end-stage liver disease model score for short-term prognosis of patients with decompensated hepatitis B liver cirrhosis. Method: 1. The medical records and follow-up results of 80 patients with decompensated hepatitis B liver cirrhosis admitted to Jiangsu Subei people's Hospital from November 2015 to July 2016 were collected and their serum CHE levels were analyzed and compared with those of 30 healthy subjects. 2. The correlation between CHE level and MELD score in 80 patients with decompensated hepatitis B liver cirrhosis was analyzed. 80 patients were followed up for prognosis. According to the survival of 3 months, they were divided into survival group and death group. The working characteristic curve (receiver operating characteristic curve,ROC curve of serum cholinesterase and MELD scoring system for 3 months was drawn to evaluate the ability of serum CHE,MELD score to predict the prognosis of patients with decompensated hepatitis B liver cirrhosis at 3 months. The survival curve of Kaplan-Meier was established by using the cut-off value of ROC curve, and the value of serum CHE combined with MELD score in evaluating the prognosis of patients was analyzed. Result: 1. The mean serum che value of decompensated hepatitis B cirrhotic patients was (3.23 卤1.73) KU/L, which was significantly lower than that of the normal control group (5.64 卤2.13) KU/L (P 0.01). The level of cholinesterase decreased with the increase of MELD score in patients with decompensated hepatitis B liver cirrhosis. through pearson correlation analysis, it was found that there was a significant negative correlation between meld score and serum CHE. According to the ROC curve, the cut-off values of CHE,MELD were 2.09 KU and 28.5, respectively. the sensitivity and specificity of using MELD score 鈮，

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