【摘要】 目的:探讨淋巴细胞计数与单核细胞计数比值(LMR)联合整合终末期肝病模型(iMELD)评分预测慢加急性肝衰竭(ACLF)患者短期预后的价值。方法:回顾性分析2020年1月至2022年8月南通市第三人民医院诊治的ACLF患者的临床资料。根据随访90 d时患者生存状态分为生存组(n=87)与死亡组(n=66),分析LMR联合iMELD评分与ACLF预后预测模型的相关性。logistic回归分析ACLF患者死亡的危险因素；采用Pearson相关性检验分析LMR与凝血酶原活动度(PTA)、终末期肝病评分模型关系；运用受试者工作特征曲线(ROC)评价LMR联合iMELD对ACLF患者预后的临床效能。结果:共纳入ACLF患者153例，其中90 d内死亡患者66例。存活组患者LMR、PTA、单核细胞计数均大于死亡组，差异具有统计学意义(P<0.05);死亡组患者肌酐、国际标准比值(INR)、MELD评分、MELD-Na评分、iMELD评分均高于生存组，差异均有统计学意义(P<0.05)。Pearson相关分析结果显示LMR与PTA评分(r=0.174,P<0.05)呈正相关；与MELD评分(r=-0.243,P<0.05)、MELD-Na评分(r=-0.255,P<0.05)、iMELD评分(r=-0.254,P<0.05)均呈负相关。LMR联合iMELD评分预测患者90 d预后的ROC曲线下面积为0.849,均高于单独检测。结论:LMR、iMELD评分是影响ACLF患者预后的重要参数，LMR联合iMELD评分可提高对ACLF患者预后的预测价值，对临床有一定的指导意义。更多还原

【Abstract】 Objective:To investigate the value of lymphocyte-monocyte ratio(LMR) combined with iMELD score to predict the short-term prognosis of patients with acute-on-chronic liver Failure(ACLF).Methods:Retrospective analysis of clinical data of ACLF patients treated at the Third People′s Hospital of Nantong City from January 2020 to August 2022. The patients were divided into survival group(n=87) and death group(n=66) according to their survival status at 90 days of follow-up, and the correlation between LMR combined with iMELD score and prognostic prediction model of ACLF was analyzed. Logistic regression was used to analyze the risk factors of death in ACLF patients. Pearson correlation test was used to analyze the correlation between LMR, prothrombin activity(PTA), and iMELD score. The receiver operating characteristic curve(ROC) was used to evaluate the clinical efficacy of LMR combined with iMELD on the prognosis of ACLF patients.Results:A total of 153 ACLF patients were included, of which 66 died within 90 days. The LMR, PTA, and monocyte count were all greater in the surviving group than in the dying group, and the differences were statistically significant(P<0.05). The creatinine, INR, MELD score, MELD-Na score, and iMELD score were all higher in the dying group than in the surviving group, and the differences were statistically significant(P<0.05). Pearson correlation analysis showed that LMR was positively correlated with PTA score(r=0.174, P=0.002) and negatively correlated with MELD score(r=-0.243, P=0.003), MELD-Na score(r=-0.255, P=0.002), and iMELD score(r=-0.254 P=0.002). The area under the ROC curve of the combined LMR and iMELD scores was 0.849, which was higher than that of the individual tests.Conclusion:The LMR and iMELD scores are important parameters affecting the prognosis of ACLF patients, and the combination of LMR and iMELD scores can improve the predictive value of the prognosis of ACLF patients, which has certain clinical significance.更多还原