论文部分内容阅读
目的 评估全新无创肝病模型血小板-白蛋白-胆红素指数(PALBI)判断肝硬化急性上消化道出血(AUGIB)患者预后的准确性.方法 回顾性分析277例因肝硬化AUGIB住院且资料完整的患者,收集每例患者血小板、总胆红素、白蛋白、肌酐、国际标准化比值、肝硬化病因等资料.通过单因素和多因素logistic回归分析寻找肝硬化AUGIB患者死亡的独立危险因素,方差分析对比终末期肝病模型(MELD)和PALBI各分级之间的差异,利用Pearson相关分析评估MELD与APLBI的相关性,并通过受试者工作特征曲线(ROC)分别比较两者对肝硬化AUGIB患者短期和长期死亡的预测能力.结果 肝硬化AUGIB患者短期(30 d内)和长期(1年内)死亡率分别为13.7％、23.5％,住院时间(9.1±3.9)d.经单因素和多因素证实高MELD评分、高PALBI指数为患者死亡的独立危险因素,OR值分别为1.17、4.43(P均＜0.05);两者Pearson相关分析显示呈正相关(r=0.735,P＜0.05);对MELD-a级患者进行PALBI评分,其中PALBI-1级和2级患者1年死亡率分别是7.0％、17.8％,差异有统计学意义(X2=4.033,P＜0.05);利用ROC曲线对比MELD、PALBI对患者短期死亡的预测能力,PALBI的AUC为0.767(95％ CI:0.712～0.815),MELD评分的AUC为0.651(95％ CI:0.591～0.707),差异有统计学意义(Z =2.328,P＜0.05);对比PALBI和MELD对患者长期死亡的预测能力,两者AUC分别为0.731 (95％ CI:0.674～0.782)、0.754(95％ CI:0.699～0.804),差异无统计学意义(Z=0.828,P＞0.05).结论 PALBI较MELD评分对肝硬化AUGIB患者死亡有着更好的预测效果,PALBI对MELD-a级患者可以实现更精细的预后分级,并且对患者短期(住院和出院30 d内)和长期(出院后1年内)死亡情况均保持着良好的预测能力.PALBI作为一项全新的肝病模型可作为判断肝硬化AUGIB患者预后的有效无创手段.“,”Objective To evaluate the accuracy of the new non-invasive liver disease model platelet-albumin-bilirubin index (PALBI) in the diagnosis of patients with acute upper gastrointestinal hemorrhage (AUGIB) due to cirrhosis.Methods 277 patients with AUGIB due to cirrhosis were analyzed retrospectively.The data of platelet,total bilirubin,albumin,creatinine,international standardized ratio and etiology of cirrhosis were collected.Univariate and multivariate logistic regression analysis was used to identify independent risk factors for death in patients with cirrhosis complicated by AUGIB.Analysis of variance was used to compare the differences between the model for end-stage liver disease (MELD) and PALBI grades.Pearson correlation analysis was used to assess the association between MELD and PALBI.The operating characteristic curve (ROC) was used to compare the predictive power of both for short-term and long-term mortality in patients with cirrhosis complicated by AUGIB.Results The short-term and long-term mortality rates of patients with cirrhosis complicated by AUGIB were 13.7％ and 23.5％,respectively.The average hospital stay was (9.1 ± 3.9) days.The high MELD score and high PALBI index were confirmed as independent risk factors of death by single factor and multiple factors [odds ratio (OR) =1.17,4.43;P ＜0.05];the Pearson correlation analysis showed there was a positive correlation between MELD score and PALBI index (r =0.735,P ＜ 0.05).The PALBI score was scored in MELD-a patients,further subdivided into PALBI-1a and PALBI-1b.There were statistical difference in the 1-year mortality rate between the two groups (7.0％ vs 17.8％,x2 =4.033,P ＜ 0.05).The ROC curve was used to compare the predictive power of MELD and PALBI for short-term mortality.The area under curve (AUC) of PALBI was 0.767 (95％ CI:0.712-0.815),while the AUC of the MELD score was 0.651 (95％ CI:0.591-0.707),with statistically significant difference (Z =2.328,P ＜ 0.05).The predictive power of PALBI and MELD for long-term mortality were 0.731 (95％ CI:0.674-0.782),0.754 (95％ CI:0.699-0.804),but the difference was not statistically significant (Z =0.828,P ＞ 0.05).Conclusions PALBI has a better predictive effect on patients with cirrhosis complicated by AUGIB than MELD scores.PALBI can achieve a more precise prognosis classification for patients with MELD-a,and maintain a good prediction ability on the short-term (within 30 days of hospitalization and discharge) and long-term (within 1 year after discharge) mortality of patients.As a new liver disease model,PALBI can be used as an effective non-invasive means to judge the prognosis of patients with liver cirrhosis complicated by AUGIB.