【摘要】 目的:探讨以血清乳酸脱氢酶(lactate dehydrogenase,LDH)水平及LDH和终末期肝病模型(model for end-stage liver disease,MELD)评分结合建立的模型MELD-LDH评估慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)患者预后的效能,并对血清LDH水平与不同程度多系统损伤的关系进行研究,以期提高对该病的认识和救治水平。方法:采用回顾性研究方法,收集2015年10月—2019年8月南京医科大学第一附属医院收治的119例ACLF患者的临床资料。按照入院后28 d的预后情况,分为存活组(n=90)和死亡组(n=29)。采用单因素和多因素回归分析法,分析影响ACLF患者预后的相关因素,探讨血清LDH水平与不同程度多系统损伤的关系,建立MELD-LDH模型并验证其效能。结果:回归分析显示,血清LDH水平是影响ACLF患者预后的独立危险因素(OR=1.015,P=0.002)。并发肾衰竭、肝性脑病患者的血清LDH水平显著较高(P=0.002,P=0.018)。MELD-LDH模型预测28 d、90 d临床转归的效能明显优于MELD评分(P=0.028,P=0.002)。结论:高血清LDH水平是ACLF患者28 d死亡的独立危险因素,且与并发肾衰竭、肝性脑病密切相关;LDH和传统的MELD评分结合的MELD-LDH模型对ACLF患者28 d、90 d预后的预测效能较好。更多还原

【Abstract】 Objective:This article aims to investigate the efficiency of a model combined serum lactate dehydrogenase(LDH)level and model for end-stage liver disease(MELD)MELD-LDH on evaluating the prognosis of patients with acute-on-chronic liver failure(ACLF),and to study the correlation between serum LDH and different levels of multiple system damage in order to improve the awareness and treatment of ACLF. Methods:This study used a retrospective method to collect clinical data of 119 patients with ACLF admitted to the First Affiliated Hospital of Nanjing Medical University from October 2015 to August 2019. According to the prognosis of 28 days after admission,they were divided into the survival group(n=90)and the death group(n=29). Univariate and multivariate regression analysis methods were used to analyze the relevant factors affecting the prognosis of patients with ACLF. MELD-LDH model was established to verify its efficacy and explore the correlation between serum LDH and the levels of multiple organ damage. Results:The results showed that serum LDH levels were independent risk factors affecting the prognosis of patients with ACLF(OR=1.015,P=0.002). LDH was significantly higher in patients with renal failure and hepatic encephalopathy(P=0.002,P=0.018). MELD-LDH model was significantly better than MELD scores in predicting 28-day and 90-day clinical outcomes(P=0.028,P=0.002). Conclusion:High serum LDH level is an independent risk factor for 28-day mortality in patients with ACLF,and it is closely related to renal failure and hepatic encephalopathy. MELD-LDH model established by combining LDH and MELD scores has a better predictive effect on the 28-day and 90-day prognosis of patients with ACLF.更多还原