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目的:通过对几种不同评分系统比较,找出更适合乙肝相关慢加急性肝衰竭患者短期预后评估的方法。方法:将142例乙肝相关慢加急性肝衰竭患者根据其3个月后的存活及死亡情况,分为存活组(n=72)及病死组(n=70),分别计算CTP、MELD、ANN、SOFA、SMSVH、LRM等评分,行ROC曲线分析,计算曲线下面积,并进行比较。结果:ROC曲线下面积从大到小分别为ANN、SOFA、LRM、MELD、CTP、SMSVH,相应数值分别为0.92、0.89、0.89、0.87、0.78和0.69。ANN、SOFA、LRM、MELD的AUC之间比较差异无统计学意义(P>0.05),ANN、SOFA、LRM、MELD的AUC值>CTP、SMSVH,差异有统计学意义(P均<0.05),CTP的AUC值>SMSVH,差异有统计学意义(P<0.05)。结论 :ANN、SOFA、LRM、MELD较好;CTP稍差;SMSVH最差,不适用于乙肝相关慢加急性肝衰竭患者短期预后判断。ANN可能为最佳评分系统,但仍需大样本、多中心、动态的临床观察来证实。
OBJECTIVE: To compare short-term prognosis of patients with chronic hepatitis B and acute liver failure with hepatitis B by comparing several different scoring systems. Methods: One hundred and seventy-two patients with chronic hepatitis B-related acute and chronic liver failure were divided into survival group (n = 72) and dead group (n = 70) according to their survival and death after 3 months. , SOFA, SMSVH, LRM and other scores, line ROC curve analysis, calculate the area under the curve, and compared. Results: The areas under the ROC curve were ANN, SOFA, LRM, MELD, CTP and SMSVH, respectively. The corresponding values were 0.92, 0.89, 0.89, 0.87, 0.78 and 0.69 respectively. There was no significant difference in AUC between ANN, SOFA, LRM and MELD (P> 0.05), AUC values of ANN, SOFA, LRM and MELD were higher than CTP and SMSVH (P <0.05) CTP AUC> SMSVH, the difference was statistically significant (P <0.05). Conclusion: ANN, SOFA, LRM, MELD are better; CTP is slightly worse; SMSVH is the worst, which is not suitable for judging short-term prognosis of patients with chronic hepatitis B and acute liver failure. ANN may be the best scoring system, but still need a large sample, multicenter, dynamic clinical observation to confirm.