MELD评分联合中性粒细胞/淋巴细胞比值对HBV相关慢加急性肝衰竭短期预后的预测价值

摘要

目的 探讨MELD评分系统结合中性粒细胞/淋巴细胞比值(NLR)对预测HBV相关慢加急性肝衰竭(HBV-ACLF)短期预后的价值.方法 回顾性分析2014年6月-2016年12月西南医科大学附属医院收治的133例HBV-ACLF患者,根据3个月的预后情况分为死亡组(n=72)和存活组(n=61).在入院24 h内测定患者NLR和肝肾功能、凝血指标,并进行MELD评分.计量资料2组间比较采用t检验,多因素二分类logistic回归分析各相关因素与HBV-ACLF患者疾病转归的关系.绘制受试者工作特征曲线(ROC曲线)分析MELD评分联合NLR的ROC曲线下面积(AUC)以评价二者结合对HBV-ACLF患者短期预后的预测价值.结果 死亡组年龄、TBil、血清肌酐(Cr)、PT、国际标准化比值、MELD评分、NLR均大于存活组,PTA小于存活组,差异均有统计学意义(t值分别为-5.888、-2.064、-3.707、-3.517、-3.410、-5.908、-2.830、4.169,P值均<0.05).年龄、Cr、MELD评分与NLR为预测HBV-ACLF患者预后的危险因素[比值比(OR)分别为1.110、1.092、1.305、1.289,P值均<0.05],PTA为预测HBV-ACLF患者预后的保护因素(OR=0.872,P<0.05).MELD评分较NLR的AUC高,分别为0.777和0.680,PTA的AUC为0.304,NLR联合MELD评分的AUC为0.843,当PTA=35%,MELD评分为23.29分,NLR为2.06时,对应的Youden指数最大,分别是0.32、0.28和0.43.当MELD评分>23.29,且NLR>2.06时,死亡概率为92.6%.结论 MELD评分联合NLR对HBV-ACLF患者短期预后的预测具有更好的价值.%Objective To investigate the value of Model for End-Stage Liver Disease(MELD)score combined with neutrophil-lympho-cyte ratio(NLR)in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF). Methods A retrospective analysis was performed for the clinical data of 133 HBV-ACLF patients who were admitted to The Affiliated Hospital of Southwest Medical University from June 2014 to December 2016,and according to the prognosis at 3 months after treat-ment,these patients were divided into death group with 72 patients and survival group with 61 patients. NLR,hepatic and renal function, and coagulation function were measured within 24 hours after admission,and the MELD score was also determined. The t-test was used for comparison of continuous data between groups,and a multivariate dichotomous logistic regression analysis was used to identify the association of related factors with the prognosis of HBV-ACLF patients. The receiver operating characteristic(ROC)curve was used to analyze the are-a under the ROC curve(AUC)of MELD score combined with NLR,in order to evaluate the value of MELD score combined with NLR in predicting the short-term prognosis of HBV-ACLF patients. Results Compared with the survival group,the death group had significantly higher age,total bilirubin,creatinine(Cr),prothrombin time,international normalized ratio,MELD score,and NLR and a significantly lower prothrombin time activity(PTA)(t= -5.888,-2.064,-3.707,-3.517,-3.410,-5.908,-2.830 and 4.169,all P<0.05). Age(odds ratio[OR]=1.110),Cr(OR=1.092),MELD score(OR=1.305),and NLR(OR=1.289)were risk factors for the prognosis of HBV-ACLF patients,while PTA was a protective factor(OR=0.872,P<0.05). MELD score had a higher AUC than NLR(0.777 vs 0.680);PTA had an AUC of 0.304,and NLR combined with MELD score had an AUC of 0.843. PTA,MELD score,and NLR had the highest Youden index of 0.32,0.28,and 0.43,respectively,at cut-off values of 35%,23.29,and 2.06. The probability of death was 92.6% when the MELD score exceeded 23.29 and NLR exceeded 2.06. Conclusion MELD score combined with NLR has a good value in predicting the short-term prognosis of patients with HBV-ACLF.