肝移植标准数学模型和CTP评分评估肝衰竭患者预后临床价值的比较研究

摘要

目的 比较肝移植标准数学模型(LTS)评分和Child-Turcotte-Pugh(CTP)评分对肝衰竭患者预后的临床评估价值.方法 回顾性分析2004年1月至2008年12月入住本院150例肝衰竭患者的病历资料,按患者入院后90 d的生存情况分为生存组(48例)和死亡组(102例).收集患者入院24 h内的LTS评分和CTP评分系统所需要的相关资料,分别计算LTS评分和CTP评分,比较生存组和死亡组的LTS评分和CTP评分.采用Spearman等级相关分析法分析LTS评分和CTP评分与肝衰竭预后的相关性;采用受试者工作特征曲线(ROC曲线)下面积(AUC)比较两个评分系统的预测能力.结果 生存组LTS评分[(38.88±4.27)分]和CTP评分[(11.25±0.97)分]均显著低于死亡组[LTS评分:(52.63±10.65)分,CTP评分:(12.18±1.22)分,均P＜0.01].LTS评分与肝衰竭预后的秩相关系数(r_s=0.651,P＜0.01)高于CTP评分(r_s=0.366,P＜0.01).LTS评分的AUC为0.897,敏感性(SN)为76.52%,特异性(SP)为91.18%,阳性预测值(PV+)为94.39%,阴性预测值(PV-)为66.67%,约登指数为0.677;CTP评分的AUC为0.716,SN为40.91%,SP为92.65%,PV+为91.53%,PV-为44.68%,约登指数为0.336.结论 LTS评分在评估肝衰竭患者预后的临床价值优于CTP评分.%Objective To compare the clinical value of the liver transplantation standard (LTS)mathematical model score and Child-Turcotte-Pugh (CTP) score in evaluating the prognosis of liver failure.Methods The clinical data of 150 liver failure patients were analyzed retrospectively.All the patients who were admitted from January 2004 to December 2008 were divided into survival group (n=48) and death group (n=102) in regard to their 90-day survival after their admission.LTS score and CTP score were calculated according to their respective clinical data within 24 hours after their admission.Comparison between LTS score and CTP score was conducted respectively between the survival group and death group.The correlation between LTS score/CTP score and the prognosis of liver failure was made by Spearman rank correlation.The ability of LTS score and CTP score to predict the outcome of liver failure was compared with the receiver operating characteristic (ROC) curve.Results The LTS score and CTP score of survival group were 38.88±4.27 and 11.25±0.97,respectively,which were lower than those of death group (52.63±10.65 and 12.18±1.22,both P＜0.01).The correlation coefficient of LTS score and the prognosis of liver failure (r_s=0.651,P＜0.01) was higher than that of CTP score (r_s=0.366,P＜0.01).The area under ROC curve (AUC) of LTS score was 0.897,sensitivity (SN) was 76.52%,specificity (SP) was 91.18%,positive predictive value (PV+) was 94.39%,negative predictive value (PV-) was 66.67 %,and Youden index was 0.677,respectively.The AUC of CTP score was 0.716,those of SN,SP,PV+,PV- and Youden index were 40.91%,92.65%,91.53%,44.68% and 0.336,respectively.Conclusion The LTS score is better than the CTP score in evaluating the prognosis of liver failure.