肝脏
肝髒
간장
CHINESE HEPATOLOGY
2015年
4期
291-294
,共4页
吴婧%倪鎏达%张懿%江甫柱%孙双双%程明亮%傅青春%陈成伟
吳婧%倪鎏達%張懿%江甫柱%孫雙雙%程明亮%傅青春%陳成偉
오청%예류체%장의%강보주%손쌍쌍%정명량%부청춘%진성위
慢加急性肝功能衰竭%有效肝血流量%短期预后
慢加急性肝功能衰竭%有效肝血流量%短期預後
만가급성간공능쇠갈%유효간혈류량%단기예후
Acute-on-chronic live failure%Effective hepatic blood flow%Short-term prognosis
目的：探索有效肝血流量（EHBF）对慢加急性肝功能衰竭（ACLF）短期预后评估价值。方法回顾性分析63例 ACLF 患者的临床资料，以3个月内死亡为终点，在确诊 ACLF 后24 h 内采用脉搏染料光密度法测定 EHBF、ICGR15值，同时记录24 h 内各项临床化验指标。结果63例患者中21例死亡；EHBF 与 ALT、TBil、DBil 、Alb 、GGT有较好的相关性（r＝－0.26、－0.37、－0.34、－0.29、0.48）；提示 EHBF 是影响 ACLF 预后的主要相关因素之一，EHBF ROC 曲线下面积为0.669（95％ CI ：0.539～0.782），与 MELD 评分0.711（95％ CI ：0.510～0.758，P ＝0.07）相比无显著差异，而明显优于 CTP 分级的0.581（95％ CI ：0.495～0.738，P ＜0.01）和 KCH 标准0.554（95％ CI ：0.458～0.722，P ＜0.01）；EHBF ROC 曲线截断值对预后预测也有一定价值，当 EHBF≤0.221时病死率为44.7％，EHBF＞0.221时为16％（χ2＝5.6，P ＝0.018）。结论 EHBF 能较准确预测 ACLF 患者的短期预后。
目的：探索有效肝血流量（EHBF）對慢加急性肝功能衰竭（ACLF）短期預後評估價值。方法迴顧性分析63例 ACLF 患者的臨床資料，以3箇月內死亡為終點，在確診 ACLF 後24 h 內採用脈搏染料光密度法測定 EHBF、ICGR15值，同時記錄24 h 內各項臨床化驗指標。結果63例患者中21例死亡；EHBF 與 ALT、TBil、DBil 、Alb 、GGT有較好的相關性（r＝－0.26、－0.37、－0.34、－0.29、0.48）；提示 EHBF 是影響 ACLF 預後的主要相關因素之一，EHBF ROC 麯線下麵積為0.669（95％ CI ：0.539～0.782），與 MELD 評分0.711（95％ CI ：0.510～0.758，P ＝0.07）相比無顯著差異，而明顯優于 CTP 分級的0.581（95％ CI ：0.495～0.738，P ＜0.01）和 KCH 標準0.554（95％ CI ：0.458～0.722，P ＜0.01）；EHBF ROC 麯線截斷值對預後預測也有一定價值，噹 EHBF≤0.221時病死率為44.7％，EHBF＞0.221時為16％（χ2＝5.6，P ＝0.018）。結論 EHBF 能較準確預測 ACLF 患者的短期預後。
목적：탐색유효간혈류량（EHBF）대만가급성간공능쇠갈（ACLF）단기예후평고개치。방법회고성분석63례 ACLF 환자적림상자료，이3개월내사망위종점，재학진 ACLF 후24 h 내채용맥박염료광밀도법측정 EHBF、ICGR15치，동시기록24 h 내각항림상화험지표。결과63례환자중21례사망；EHBF 여 ALT、TBil、DBil 、Alb 、GGT유교호적상관성（r＝－0.26、－0.37、－0.34、－0.29、0.48）；제시 EHBF 시영향 ACLF 예후적주요상관인소지일，EHBF ROC 곡선하면적위0.669（95％ CI ：0.539～0.782），여 MELD 평분0.711（95％ CI ：0.510～0.758，P ＝0.07）상비무현저차이，이명현우우 CTP 분급적0.581（95％ CI ：0.495～0.738，P ＜0.01）화 KCH 표준0.554（95％ CI ：0.458～0.722，P ＜0.01）；EHBF ROC 곡선절단치대예후예측야유일정개치，당 EHBF≤0.221시병사솔위44.7％，EHBF＞0.221시위16％（χ2＝5.6，P ＝0.018）。결론 EHBF 능교준학예측 ACLF 환자적단기예후。
Objective To investigate short-term prognostic value of noninvasive effective hepatic blood flow (EHBF) in patients with acute-on-chronic live failure (ACLF).Methods Clinical data of 63 patients diagnosed with acute on chronic liver failure was retrospectively analyzed.End point was death within three months after diagnosed.EHBF and indocyanine green retention rate at 15 min (ICGR15)were performed within 24 hours after diagnosis.Meanwhile,clinical biochemical indicators were collected.Results In total 63 patients,21 cases died (33.3%),42 cases survived(66.7%);EHBF had significant correlation with ALT ,TBIL,DBIL,ALB,and GGT (r = - 0.26,- 0.37,- 0.34,- 0.29,0.48, respectively);prognostic factors analysis showed that effective hepatic blood flow was one of main factors affecting prognosis of ACLF.Area under the curve generated by ROC curves was 0.669 (95% CI 0.539,0.782)for EHBF,0.711 (95% CI 0.510,0.785;P =0.07 )for MELD,there was no significant difference between them.Both EHBF and MELD were significantly more superior than CTP grade (AUC=0.581 ,95% CI 0.459,0.738;P <0.05 )or KCH criteria (AUC=0.554,95% CI 0.458,0.722;P <0.05 ),respectively.The cut-off value of EHBF was 0.221 .The mortality rate was 44.7% when EHBF was less than 0.221 ,while the mortality rate was 16% when EHBF was higher than 0.221 (χ2 =5.6, P =0.018).Conclusion EHBF could accurately predict short-term prognosis of patients with ACLF.
