【摘要】 目的探讨血清甲状腺激素、血脂水平、联合血钠的终末期肝病模型(MELD-Na)评分对行血浆置换治疗的慢加急性肝衰竭患者短期预后的评估价值。方法回顾性分析147例接受血浆置换治疗的慢加急性肝衰竭患者临床资料,根据患者3个月的预后情况分为生存组(71例)和死亡组(76例)。血浆置换前检测肝功能、肾功能、血钠、凝血功能、甲状腺激素[包括TSH、T4、T3、FT4、FT3],以及血脂[包括TG、高密度脂蛋白(HDL)、TC、低密度脂蛋白(LDL)、载脂蛋白A(apoA)、载脂蛋白B(apoB)],并计算终末期肝病模型(MELD)、MELD-Na评分。采用ROC曲线、多因素logistic回归分析等方法评估甲状腺激素、血脂水平、MELD-Na评分预测行血浆置换治疗的慢加急性肝衰竭患者3个月预后的准确性。结果死亡组白蛋白、血钠、TSH、T4、T3,TG、HDL、TC、LDL、apoA、apoB均低于生存组,FT3、总胆红素(TBil)、INR、MELD评分、MELD-Na评分均高于生存组,差异均有统计学意义(P<0.01或0.05)。TSH、T4、T3、TG、HDL、apoA、TSH+T3、TG+apoA、MELD评分、TSH+T3+TG+apoA预测慢加急性肝衰竭患者短期预后的AUC分别为0.754、0.706、0.772、0.755、0.769、0.745、0.798、0.824、0.860、0.881,具有临床应用价值;MELD-Na、TSH+T3+MELD-Na、TG+apoA+MELD-Na、TSH+T3+TG+apoA+MELD-Na的AUC分别为0.904、0.923、0.932、0.955,临床应用价值较高。多因素回归分析结果显示,TSH、T3、TG、apoA、MELD评分、MELD-Na评分是慢加急性肝衰竭患者短期死亡的独立危险因素(P<0.05或0.01)。结论血清甲状腺激素、血脂水平、MELD-Na评分对预测慢加急性肝衰竭患者的短期预后具有良好的临床应用价值。更多还原

【Abstract】 Objective To investigate the short-term prognostic value of serum thyroid hormones, blood lipid levels, end-stage liver disease-sodium(MELD-Na) score in patients with acute on chronic liver failure undergoing plasma exchange. Methods A retrospective analysis was performed in 147 patients with acute on chronic liver failure undergoing plasma exchange. The patients were divided into survival group(n=71) and death group(n=76) according to the prognosis at 3-months after treatment. The hepatic biological indices, renal function, serum sodium ion concentration(Na~+), blood coagulation, serum thyroid hormones(including thyroid stimulating hormone [TSH], thyroxin [T4], triiodothyronine [T3], free thyroxin [FT4], free triiodothyronine [FT3]), blood lipids(including triglyceride [TG], high density lipoprotein [HDL], total cholesterol [TC], low density lipoprotein [LDL], apolipoprotein A [apoA], apolipoprotein B [apoB]) were determined before plasma exchange. MELD and MELD-Na scores were calculated. The receiver operating characteristic(ROC) curve and logistic regression model were used to evaluate the roles of thyroid hormones, blood lipid levels, MELD-Na score in predicting 3-month prognosis of patients with acute on chronic liver failure undergoing plasma exchange. Results The levels of albumin, Na~+,TSH, T4, T3, TG, HDL, TC, LDL, apoA and apoB in the death group were significantly lower than those in the survival group, while FT3 level, total bilirubin(TBil),INR,MELD score and MELD-Na score in the death group were significantly higher than those in the survival group(P<0.01,0.05). The area under ROC curve(AUC) of TSH, T4, T3, TG, HDL, apoA, TSH combined with T3, TG combined with apoA, MELD score, TSH and T3 combined with TG and apoA was 0.754, 0.706, 0.772, 0.755, 0.769, 0.745, 0.798, 0.824, 0.860, 0.881,showing clinical value. The AUC of MELD-Na, TSH and T3 combined with MELD-Na, TG and apoA combined with MELD-Na, MELD-Na combined with TSH, T3,TG and apoA was 0.904,0.923, 0.932, 0.955,showing a better clinical value. The multi-factor logistic regression analysis showed that the TSH, T3, TG, apoA, MELD, and MELD-Na score were independent risk factors of short-term death in patients with acute on chronic liver failure undergoing plasma exchange. Conclusion The serum thyroid hormones, blood lipid levels, MELD-Na score have a good value in evaluating short-term prognosis in patients with acute on chronic liver failure undergoing plasma exchange.更多还原