目的：观察慢加急性肝功能衰竭（acute-on-chronic liver failure，ACLF）患者MELD评分模型（model for end-stage liver disease，MELD）和降钙素原（proprocalcitonin，PCT）的变化，评价MELD评分联合PCT对判断ACLF患者近期预后的价值。方法选择2012年6月至2015年3月广西中医药大学第一附属医院肝病治疗中心及广西田东县中医院肝病科ACLF住院患者83例，分为生存组43例和死亡组40例，比较两组患者的TBil、Cr、INR、MELD评分和PCT等的变化。结果①治疗12周结束时，全部83例ACLF患者中共病死40例，总病死率49.43%。②治疗前比较2组TBil、Cr、INR、MELD评分和PCT，差异无统计学意义（t=0.594、0.644、0.215、1.326、0.053；P=0.554、0.522、0.830、0.188、0.958）；治疗第2周后两组间比较，TBil、INR差异无统计学意义（t =0.994、1.160，P =0.324、0.250），Cr、PCT、MELD评分差异有统计学意义（t =2.779、18.400、4.948，P=0.007、0.000、0.000）。治疗第4周后两组间比较，TBil、Cr、INR、PCT、MELD评分差异有统计学意义（t=5.346、3.951、3.571、15.995、8.085，P =0.000）。③MELD评分联合PCT判断ACLF 12周内病死的AUC为0.751，高于单纯MELD评分的AUC 0.722和PCT的AUC 0.684。结论MELD评分联合降钙素原对ACLF患者近期预后预测效果良好。%Objective To observe the changes of model for end-stage liver disease (MELD) scores and proprocalcitonin(PCT) of patients with acute-on-chronic liver failure(ACLF), and to evaluate the predictive value of MELD combined with PCT on the short-term prognosis in patients with ACLF. Methods Total of 83 patients with ACLF in the First Affiliated Hospital of Guangxi University of Chinese Medicine and Tiandong Chinese Medicine Hospital from June 2012 to March 2015 were selected and divided into survival group (43 cases) and death group (40 cases), the changes of biochemical indexes, MELD score and PCT in the two groups were compared. Results①Total of 40 patients died in all 83 patients with ACLF at the end of the 12 weeks, the total mortality rate was 49.43%.②There were no signiifcant differences of all indexes between two groups before treatment (t=0.594, 0.644, 0.215, 1.326, 0.053;P=0.554, 0.522, 0.830, 0.188, 0.958). The difference in TBil and INR had no statistical signiifcance (t=0.994, 1.160;P=0.324, 0.250), but the difference in Cr, PCT and MELD scores had statistical signiifcance (t=0.745, P=0.000) between survival group and death group after two weeks. The differences of TBil, Cr, INR, PCT and MELD scores were statistically signiifcant between the two groups after 4 weeks (t=5.346, 3.951, 3.571, 15.995, 8.085; P= 0.000). ③The AUC of MELD score combined with PCT was 0.751, which was higher than 0.722 only by MELD score and 0.684 by PCT within 12 weeks for patients with ACLF. Conclusion MELD score combined with PCT has a good predictive value on the short-term prognosis in patients with ACLF.
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