PBI简易模型预测慢加急性肝衰竭预后的临床价值

摘要

目的：探讨PBI简易模型预测慢加急性肝衰竭（ACLF）患者预后的临床价值。方法将213例ACLF患者按治疗后临床转归分为好转存活组103例及恶化死亡组110例，于患者入院时至出院前应用PBI简易模型和终末期肝病模型（MELD）对两组患者进行评估，比较两种评估方法评分差异及变化曲线，应用受试者工作特征（ROC）曲线分析 PBI与MELD对ACLF预后的预测效能。结果入院时，好转存活组 PBI 评分为（14．99±11．28）分，明显高于与恶化死亡组的（7．98±7．45）分（P＜0．01），MELD评分为（25．69±5．69）分，明显低于恶化死亡组的（31．13±7．42）分（P＜0．01）。存活组入院时的PBI评分明显低于出院前（P ＜0．05），死亡组入院时 PBI评分高于出院前（P＜0．05），好转存活组入院时的MELD评分高于出院前（P＜0．05），恶化死亡组入院时的MELD评分低于出院前（P＜0．05）。两组患者的统计曲线变化趋势均呈完全反向状态。在住院初期，PBI模型及MELD模型的曲线下面积分别为0．75、0．71。结论 PBI简易模型评分评估ACLF患者预后具有较好的临床价值。%Objective To explore the clinical value of PBI simple model for prognostic prediction in patients with acute -on-chronic liver failure(ACLF).Methods Two hundred and thirteen patients with ACLF were divided into improvement /survival group(n=103) and deterioration/death group(n=110) according to the prognosis after treatment .The assessments on the patients in two groups were performed with PBI model and model for end-stage liver disease ( MELD) from admission to discharge .And the scores and variation curves of the two models were compared between two groups .The efficacies of prognostic prediction of the two models for ACLF was analyzed by receiver operating characteristic(ROC) curve.Results At the admission,the PBI score in the improvement/survival group was significantly higher than that in the deterioration/death group((14.99 ±11.28) vs.(7.98 ±7.45),P<0.01)),and the MELD score in the improvement/survival group was significantly lower than that in the deterioration/death group((25.69 ±5.69) vs.(31.13 ±7.42),P<0.01)).The PBI score at the admission was significantly lower in the improvement/survival group but was higher in the deterioration/death group compared to the score at the instant before discharge (P<0.05).The MELD score at the admission was higher in the improvement /survival group but was lower in the deterioration/death group compared to the score at the instant before discharge (P<0.05).The absolute opposition-based trend was observed in the changes of statistical curve in two groups .In the early days of hospitalization ,the areas under ROC curve of PBI model and MELD were 0.75 and 0.71,respectively.Conclusion PBI simple model score has a better clinical value in evaluating the prognosis of patients with ACLF.