CAJ | 학술논문

目的建立一种评价乙型肝炎慢加急性肝衰竭严重性的客观、简便、敏感的评分系统.方法中山大学附属第三医院感染病科1998年1月至2008年3月409例乙型肝炎慢加急性肝衰竭患者,分为存活组194例和死亡组215例,分析患者的肝性脑病,血清肌酐,凝血酶原活动度,血清总胆红素,感染,肝脏大小,腹水液平等7个临床指标,按照它们的严重性分别给予0～4分的评分并累计总分.将409例患者随机分为两批,第1批309例,存活144例和死亡165例用于建立评分模型及确定诊断界点.第2批100例,存活50例和死亡50例用于验证.结果慢加急性肝衰竭严重性总评分在144例生存组为6.9±3.2,165例死亡组为15.8±4.0,两组间差异有统计学意义(P(0.01).ROC曲线下面积为0.953,其最佳临界值为9.5,相应的灵敏度为0.97,特异度为0.82.根据最佳临界值将第2批患者(存活组50例,死亡组50例)分两组,≥10分组预后差,病死率为87.5%(49/56);≤9分组预后好,病死率为2.3%(1/44),两组比较差异有统计学意义(P<0.01).结论本评分系统用于评价乙型肝炎慢加急性肝衰竭严重性具有简易、敏感、客观的优点.
목적 건립일충평개을형간염만가급성간쇠갈엄중성적객관、간편、민감적평분계통.방법 중산대학부속제삼의원감염병과1998년1월지2008년3월409례을형간염만가급성간쇠갈환자,분위존활조194례화사망조215례,분석환자적간성뇌병,혈청기항,응혈매원활동도,혈청총담홍소,감염,간장대소,복수액평등7개림상지표,안조타문적엄중성분별급여0～4분적평분병루계총분.장409례환자수궤분위량비,제1비309례,존활144례화사망165례용우건립평분모형급학정진단계점.제2비100례,존활50례화사망50례용우험증.결과 만가급성간쇠갈엄중성총평분재144례생존조위6.9±3.2,165례사망조위15.8±4.0,량조간차이유통계학의의(P(0.01).ROC곡선하면적위0.953,기최가림계치위9.5,상응적령민도위0.97,특이도위0.82.근거최가림계치장제2비환자(존활조50례,사망조50례)분량조,≥10분조예후차,병사솔위87.5%(49/56);≤9분조예후호,병사솔위2.3%(1/44),량조비교차이유통계학의의(P<0.01).결론 본평분계통용우평개을형간염만가급성간쇠갈엄중성구유간역、민감、객관적우점.
Objective To establish an objective, simple and sensitive scoring system to evaluate the severity of acute-on-chronic liver failure in hepatitis B. Methods The clinical data of patients ( 194 survivals and 215 deaths) with acute-on-chronic liver failure in hepatitis B were collected and analyzed prospectively. 7 clinical indexes, including the hepatic encephalopathy, creatinine, prothrombin activity, serum total bilirubin, infection, the dimension of liver, the maximum depth of ascites, were scored objectively and simply from 0 to 4 points according to their severity . Then we calculated every patient's total score and divided the 409 patients into two groups: the one was 309 patients and the other is 100 patients. The first group was to establish the severity scoring system and define the cut-off-point, the second group was to test the severity scoring system. Results The total score of the 144 patients in the survival group was 6. 9 ±3. 2, 165 patients in the dead group was 15. 8 ±4. 0, respectively. There were significant differences ( P < 0. 01) between the two groups. The area under ROC curve was 0. 953. The cut-off-point is 9. 5. The sensitivity was 0. 97,the specificity was 0. 82. The second group patients' total score were divided into two groups:the one is ≥10 score and the other is ≤9 score. The prognosis of the first group was much worse than the second group, it's mortality rate was 87.5%; the second was 2.3% .There were significant differences between the two groups (P < 0. 01). Conclusions This scoring system was simple , sensitive and objective to evaluate the severity of acute-on-chronic liver failure in hepatitis B.