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目的建立原发性胆汁性肝硬化(PBC)发生失代偿的预测模型,验证并判断其预测价值。方法回顾性分析113例确诊时处于代偿期的PBC患者的人口统计学、实验室检查、临床表现及其他预后模型(Child-Pugh、MELD、Mayo模型)积分,研究终点为发生腹水、肝性脑病、食管胃底静脉曲张出血等失代偿。应用SPSS16.0统计软件,采用多因素(Cox回归、Kaplan-Meier(K-M)等方法建立发生失代偿的预测模型,采用接受者工作特征(ROC)曲线下面积比较所建模型与以往其他模型对PBC发生失代偿的预测价值。结果随访中位数时间31.2个月(3.37～122.43个月)期间,有21例(18.58%)患者达研究终点。所建立的PBC发生失代偿的预测模型(即D-PBC模型)指标包括AST/ALT比值、碱性磷酸酶(ALP)、胆碱酯酶(CHE)和血小板(PLT),PI=0.862×AST/ALT+0.003×ALP(U/L)-0.293×CHE(kU/L)-0.011×PLT(×10~9/L)。与其他模型相比,该预测模型的ROC曲线下面积较大,采用PI>-1.41预测PBC发生失代偿的敏感性高达0.91。结论 D-PBC模型能准确预测代偿期PBC患者临床失代偿的发生。
Objective To establish a predictive model of decompensation of primary biliary cirrhosis (PBC), validate and predict its predictive value. Methods Retrospective analysis of 113 patients with decompensated PBC diagnosed at the time of demographics, laboratory tests, clinical manifestations and other prognostic models (Child-Pugh, MELD, Mayo model) points, the end of the study ascites, liver Encephalopathy, esophageal varices bleeding and other decompensation. SPSS 16.0 statistical software was used to establish a predictive model of decompensation using multiple factors (Cox regression, Kaplan-Meier (KM), etc.). The area under the receiver operating characteristic (ROC) curve was compared with that of other models (PBC) was used to predict the decompensation of PBC.Results 21 (18.58%) patients reached the end of study during the median follow-up of 31.2 months (3.37 ~ 122.43 months) .The prediction of decompensation of PBC The indexes of model (D-PBC model) included AST / ALT ratio, alkaline phosphatase (ALP), cholinesterase (CHE) and platelet (PLT), PI = 0.862 × AST / ALT + 0.003 × ALP L) -0.293 × CHE (kU / L) -0.011 × PLT (× 10 ~ 9 / L) .Compared with other models, the area under the ROC curve of this prediction model is larger, and the occurrence of PBC is predicted by PI> -1.41 Compensatory sensitivity up to 0.91 Conclusion D-PBC model can accurately predict the decompensated PBC patients with clinical decompensation.