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五种预后模型对中国布-加综合征的预测价值

         

摘要

Objective To compare the predictive value of 5 prognostic models (Child-Pugh scoring, Clichy prognostic index [PI], New Clichy PI, Rotterdam BCS index, and BCS-TIPS PI) for Budd-Chiari syndrome (BCS) in China. Methods The clinical data of 123 patients with BCS were retrospectively analyzed, among whom 99 survived and 24 died. The indices of the 5 prognostic models were respectively calculated, and each index was compared by F-test between the survival and death groups. The area under curve (AUC), sensitivity, and specificity of the models were computed and analyzed by receiver-operator characteristic (ROC) curve. Results The indices of Child-Pugh, Clichy, New Clichy and Rotterdam BCS Index models in the death group (8.792 ± 2.0, 5.924 ± 0.783, 5.695 ± 1.81, and 0.615 ± 1.133, respectively) were significantly higher than those in the survival group (7.141 ± 1.443, 5.221 ± 0.834, 3.981 ± 1.033, and-0.148 ± 0.896, respectively, P<0.01), and only BCS-TIPS model had no significant difference between the two groups (P>0.05). The AUC of the 5 indices were 0.738, 0.720, 0.776, 0.721, and 0.502, with Youden indices of 0.370, 0.410, 0.439, 0.473, and 0.051, respectively. Conclusion Child-Pugh scoring, Clichy PI, New Clichy PI, and Rotterdam BCS Index models can distinguish survival from death in BCS patients in China. New Clichy PI has the highest predictive value and is suitable for use in China, whereas the other models have relatively low predictive values, among which BCS-TIPS model is not advisable. Meanwhile effort should be made to establish a prognostic model for BCS in China.%目的:比较和分析Child-Pugh评分、Clichy PI(克利希预后指数)、New Clichy PI(新克利希预后指数)、Rotterdam BCS index(鹿特丹BCS指数)及BCS-TIPS指数5种预后模型在中国布-加综合征(BCS)应用中的预测价值。方法回顾性分析我科收治的123例BCS患者的临床资料,其中生存组99例,死亡组24例,分别按相应模型公式计算5种预后模型的指数,应用F检验计算各预后指数在生死两组间的差异,应用受试者工作特征(ROC)曲线分别计算各模型曲线下面积(AUC)及各预后模型预测患者预后的灵敏度和特异度,进行分析。结果 Child-Pugh、Clichy、New Clichy和Rotterdam BCS模型的预后指数在死亡组中分别为8.792±2.0、5.924±0.783、5.695±1.81和0.615±1.133,均大于各模型在生存组中的相应指数(分别为7.141±1.443、5.221±0.834、3.981±1.033和-0.148±0.896),差异有统计学意义(均P<0.01),仅BCS-TIPS模型预后指数两组间差异无统计学意义(P>0.05)。5种预后指数的AUC依次为0.738,0.720,0.776,0.721和0.502,约登指数依次为0.370,0.410,0.439,0.473和0.051。结论Child-Pugh评分、Clichy PI、New Clichy PI和Rotterdam BCS index这4种模型能够区分我国BCS生死两种预后结果,其中又以New Clichy PI的预测价值最高,较适用于中国BCS患者,值得推广,另3种模型的预测价值相对较低,而BCS-TIPS模型不宜应用。同时我们仍需致力于自己的BCS预后模型。

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