CAJ | 학술논문

目的：探讨格拉斯哥预后评分（GPS）对 HBV 相关慢加急性肝衰竭（HBV -ACLF）患者死亡的预测价值。方法选取新疆医科大学第一附属医院2008年4月至2012年4月住院期间诊断为 HBV -ACLF 的患者437例，依据 GPS 评分对患者进行分组，比较不同 GPS 评分组的死亡比率。计量资料符合正态分布两组间比较采用 t 检验，三组及以上采用 F 检验；计数资料比较采用χ2检验。采用 Cox 生存回归筛选随访期间[30（5～825）d]患者死亡的的影响因素。结果HBV -ACLF 患者随访期间病死率为68.0％（297/437）。GPS 评分越高的分组住院期间消化道出血比例、肝性脑病比例、肝肾综合征比例和终末期肝病模型（MELD）就越高，且差异具有统计学意义（P 值均＜0．05）。Cox 回归分析显示，肝性脑病（Ⅰ～Ⅱ vs 无肝性脑病：HR：2.520，95％CI：1．479～4.293， P ＝0．001；Ⅲ～Ⅳ vs 无肝性脑病：HR：3．678，95％CI：1．920～7．047，P ＜0．001），肝肾综合征（HR：2．374，95％CI：1.452～3.881，P ＝0．001），消化道出血（HR：1．616，95％CI：1．153～2．262，P ＝0．004），抗病毒治疗（HR：0．668，95％CI：0．518～0.862， P ＝0.002），GPS 评分（1 vs 0：HR：2．055，95％CI：1.653～2.702，P ＝0.001；2 vs 0：HR：4.520，95％CI：3.288～6.932，P ＝0.007）和 HBV -ACLF 患者死亡密切相关。结论GPS 评分对 HBV -ACLF 患者的短期和长期死亡风险预测作用较好，且高 GPS 评分为HBV -ACLF 患者死亡的危险因素。
목적：탐토격랍사가예후평분（GPS）대 HBV 상관만가급성간쇠갈（HBV -ACLF）환자사망적예측개치。방법선취신강의과대학제일부속의원2008년4월지2012년4월주원기간진단위 HBV -ACLF 적환자437례，의거 GPS 평분대환자진행분조，비교불동 GPS 평분조적사망비솔。계량자료부합정태분포량조간비교채용 t 검험，삼조급이상채용 F 검험；계수자료비교채용χ2검험。채용 Cox 생존회귀사선수방기간[30（5～825）d]환자사망적적영향인소。결과HBV -ACLF 환자수방기간병사솔위68.0％（297/437）。GPS 평분월고적분조주원기간소화도출혈비례、간성뇌병비례、간신종합정비례화종말기간병모형（MELD）취월고，차차이구유통계학의의（P 치균＜0．05）。Cox 회귀분석현시，간성뇌병（Ⅰ～Ⅱ vs 무간성뇌병：HR：2.520，95％CI：1．479～4.293， P ＝0．001；Ⅲ～Ⅳ vs 무간성뇌병：HR：3．678，95％CI：1．920～7．047，P ＜0．001），간신종합정（HR：2．374，95％CI：1.452～3.881，P ＝0．001），소화도출혈（HR：1．616，95％CI：1．153～2．262，P ＝0．004），항병독치료（HR：0．668，95％CI：0．518～0.862， P ＝0.002），GPS 평분（1 vs 0：HR：2．055，95％CI：1.653～2.702，P ＝0.001；2 vs 0：HR：4.520，95％CI：3.288～6.932，P ＝0.007）화 HBV -ACLF 환자사망밀절상관。결론GPS 평분대 HBV -ACLF 환자적단기화장기사망풍험예측작용교호，차고 GPS 평분위HBV -ACLF 환자사망적위험인소。
Objective To assess the predictive value of Glasgow Prognostic Score (GPS)system for mortality in patients with acute -on -chronic liver failure associated with hepatitis B(HBV -ACLF).Methods The clinical data of 437 patients who were diagnosed with HBV-ACLF and admitted to the Department of Infectious Diseases,The First Affiliated Hospital of Xinjiang Medical University,from April 2008 to April 2012 were retrospectively evaluated.Patients were grouped according to their GPS scores,and the mortality rates were compared be-tween GPS groups.Continuous data in normal distribution were compared by t test between two groups and by F -test between three or more groups.Comparison of categorical data was made by chi -square test.COX proportional hazards regression was performed to identify clinical variables associated with overall survival during the follow -up period [30 (5 -825)d].Results The mortality rate of patients with HBV-ACLF was 68.0% (297 cases)during the follow -up period.The group with higher GPS scores had significantly increased proportions of individuals with gastrointestinal bleeding,hepatic encephalopathy,and hepatorenal syndrome and higher Model of End -Stage Liver Disease scores (P <0.05 across all variables).COX proportional hazards regression analysis revealed the risk factors closely associated with the mortality of patients with HBV -ACLF,which included hepatic encephalopathy (grade I -II vs absence of hepatic encephalopathy:hazard ratio,HR:2.520,95% confidence interval,CI:1.479 -4.293,P =0.001;grade III -IV vs absence of hepatic encephalopathy:HR:3.678,95% CI:1.920 -7.047,P <0.001),hepatorenal syndrome (HR:2.374,95% CI:1.452 -3.881,P =0.001),gastrointesti-nal bleeding (HR:1.616,95% CI:1.153 -2.262,P =0.004),antiviral therapy (HR:0.668,95% CI:0.518 -0.862,P =0.002) and the GPS (1 vs 0:HR:2.055,95%CI:1653 -2.702,P =0.001;2 vs 0:HR:4.520,95%CI:3.288 -6.932,P =0.007).Conclusion The GPS system has a good predictive value for short -and long -term mortality in patients with HBV -ACLF.Elevated GPS is an inde-pendent risk factor for death in patients with chronic liver failure associated with hepatitis B.