中华实验和临床感染病杂志（电子版）
中華實驗和臨床感染病雜誌（電子版）
중화실험화림상감염병잡지（전자판）
CHINESE JOURNAL OF EXPERIMENTAL AND CLINICAL INFECTIOUS DISEASES(ELECTRONIC VERSION)
2014年
5期
609-613
,共5页
梁柱石%黄献球%周德玫%莫穆隆%甘楚林%陈伟坚%黄俊%吴燕%周甦%程璐宁%钟大明
樑柱石%黃獻毬%週德玫%莫穆隆%甘楚林%陳偉堅%黃俊%吳燕%週甦%程璐寧%鐘大明
량주석%황헌구%주덕매%막목륭%감초림%진위견%황준%오연%주소%정로저%종대명
重型肝炎%血小板%胆红素%凝血酶原时间%国际标准化比率%预测模型
重型肝炎%血小闆%膽紅素%凝血酶原時間%國際標準化比率%預測模型
중형간염%혈소판%담홍소%응혈매원시간%국제표준화비솔%예측모형
Severe hepatitis%Platelet%Bilirubin%Prothrombin time%International normalized ratio%Prediction model
目的：验证血小板与胆红素乘以凝血酶原时间国际标准化比率的比值模型（PBI）对重型肝炎转归的预测价值。方法回顾性应用PBI和终末期肝病模型（MELD）测算两家医院住院的重型肝炎病例，其中好转存活组患者64例，恶化死亡组患者50例，计算两组病例住院初期、中期、末期的PBI和MELD分值，比较两组患者各期PBI、MELD分值的变化和诊断患者恶化死亡的ROC曲线下面积。结果好转存活组与恶化死亡组在住院初期、中期、末期，PBI计分的均值分别为（19.22±17.83）与（10.36±13.97）、（32.72±29.20）与（7.26±6.25）、（114.22±144.75）与（5.34±4.58），同期比较差异均具有统计学意义（P均＜0.01）。MELD计分的均值分别为（24.28±4.82）与（31.14±7.28）、（20.97±5.85）与（30.96±8.85）、（16.50±5.71）与（34.50±10.32），差异均具有统计学意义（P均＜0.01）。好转存活组与恶化死亡组患者的PBI和MELD分值变化趋势均呈反向；住院初期、中期、末期，PBI和MELD分值诊断患者恶化死亡的ROC曲线下面积分别为0.731和0.791，0.818和0.795，0.979和0.887；住院初期，PBI与MELD最佳临界点值预测恶化死亡的敏感度分别为72.00%与80.00%，特异度分别为70.31%与67.19%，准确度分别为71.05%与72.81%，阳性预测值分别为65.45%与65.57%，阴性预测值分别为76.27%与81.13%。结论 PBI分值的变化能够良好地反映重型肝炎好转存活与恶化死亡的转变规律，依据PBI变化趋势能良好地预测重型肝炎的临床转归。
目的：驗證血小闆與膽紅素乘以凝血酶原時間國際標準化比率的比值模型（PBI）對重型肝炎轉歸的預測價值。方法迴顧性應用PBI和終末期肝病模型（MELD）測算兩傢醫院住院的重型肝炎病例，其中好轉存活組患者64例，噁化死亡組患者50例，計算兩組病例住院初期、中期、末期的PBI和MELD分值，比較兩組患者各期PBI、MELD分值的變化和診斷患者噁化死亡的ROC麯線下麵積。結果好轉存活組與噁化死亡組在住院初期、中期、末期，PBI計分的均值分彆為（19.22±17.83）與（10.36±13.97）、（32.72±29.20）與（7.26±6.25）、（114.22±144.75）與（5.34±4.58），同期比較差異均具有統計學意義（P均＜0.01）。MELD計分的均值分彆為（24.28±4.82）與（31.14±7.28）、（20.97±5.85）與（30.96±8.85）、（16.50±5.71）與（34.50±10.32），差異均具有統計學意義（P均＜0.01）。好轉存活組與噁化死亡組患者的PBI和MELD分值變化趨勢均呈反嚮；住院初期、中期、末期，PBI和MELD分值診斷患者噁化死亡的ROC麯線下麵積分彆為0.731和0.791，0.818和0.795，0.979和0.887；住院初期，PBI與MELD最佳臨界點值預測噁化死亡的敏感度分彆為72.00%與80.00%，特異度分彆為70.31%與67.19%，準確度分彆為71.05%與72.81%，暘性預測值分彆為65.45%與65.57%，陰性預測值分彆為76.27%與81.13%。結論 PBI分值的變化能夠良好地反映重型肝炎好轉存活與噁化死亡的轉變規律，依據PBI變化趨勢能良好地預測重型肝炎的臨床轉歸。
목적：험증혈소판여담홍소승이응혈매원시간국제표준화비솔적비치모형（PBI）대중형간염전귀적예측개치。방법회고성응용PBI화종말기간병모형（MELD）측산량가의원주원적중형간염병례，기중호전존활조환자64례，악화사망조환자50례，계산량조병례주원초기、중기、말기적PBI화MELD분치，비교량조환자각기PBI、MELD분치적변화화진단환자악화사망적ROC곡선하면적。결과호전존활조여악화사망조재주원초기、중기、말기，PBI계분적균치분별위（19.22±17.83）여（10.36±13.97）、（32.72±29.20）여（7.26±6.25）、（114.22±144.75）여（5.34±4.58），동기비교차이균구유통계학의의（P균＜0.01）。MELD계분적균치분별위（24.28±4.82）여（31.14±7.28）、（20.97±5.85）여（30.96±8.85）、（16.50±5.71）여（34.50±10.32），차이균구유통계학의의（P균＜0.01）。호전존활조여악화사망조환자적PBI화MELD분치변화추세균정반향；주원초기、중기、말기，PBI화MELD분치진단환자악화사망적ROC곡선하면적분별위0.731화0.791，0.818화0.795，0.979화0.887；주원초기，PBI여MELD최가림계점치예측악화사망적민감도분별위72.00%여80.00%，특이도분별위70.31%여67.19%，준학도분별위71.05%여72.81%，양성예측치분별위65.45%여65.57%，음성예측치분별위76.27%여81.13%。결론 PBI분치적변화능구량호지반영중형간염호전존활여악화사망적전변규률，의거PBI변화추세능량호지예측중형간염적림상전귀。
Objective To investigate the value of model of ratio on platelet (PLT) divided by the product of bilirubin (TBil) and prothrombin international normalized ratio (PBI) for the prognosisi of severe hepatitis. The ratio of platelet and bilirubin, international normalized ratio was equal to the PLT/(TBil × INR). Methods The severe hepatitis cases in two different hospitals were measured by retrospective application of PBI and the model for end-stage liver disease (MELD), which including 64 cases of survival group and 50 cases of deteriorated group. The PBI and MELD score of patients in the two groups in early, middle, late for hospitalized were analyzed. The PBI score, the MELD score and area under the curve (AUC) of receiver operating characteristics (ROC) for the degradation rate were compared between the two groups. Results The mean of PBI score of survival group and death group during the initial hospitalization, deterioration in the intermediate and the end stage were (19.22 ± 17.83) and (10.36 ± 13.97), (32.72 ± 29.20) and (7.26 ± 6.25), (114.22 ± 144.75) and (5.34 ± 4.58), respectively;all with signiifcant differences compared to the same period (P all<0.01). The mean MELD score were (24.28 ± 4.82) and ( 31.14 ± 7.28), (20.97 ± 5.85) and (30.96 ± 8.85), (16.50 ± 5.71) and (34.50 ± 10.32), all with signiifcant differences compared to the same period (P all<0.01).Improved survival group and death group, the change tendency of PBI score and MELD score were reverse. During the early, intermediate and end stages of hospitalization, PBI score and MELD score in the diagnosis of patients with worsening ROC curve area of death were 0.731 and 0.791, 0.818 and 0.795, 0.979 and 0.887, respectively. During the early hospitalization period, the best critical point between the PBI and MELD score used to be predicted the sensitivity of deteriorating death, which were 72.00% and 80.00%, respectively;the specificity were 70.31%and 67.19%, the accuracy were 71.05%and 72.81%, the positive predicative value were 65.45% and 65.57%, and besides the negative predicative value were 76.27% and 81.13%. Conclusions PBI score variation show change law in the improved survival patients with fulminant hepatitis and the deterioration of death patients with severe hepatitis. Clinical outcomes according to PBI trends could be a good way to predict severe hepatitis.
