南方医科大学学报

南方医科大学学报 ›› 2018, Vol. 38 ›› Issue (11): 1354-.doi: 10.12122/j.issn.1673-4254.2018.11.13

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红细胞分布宽度可作为乙型肝炎相关慢加急性肝衰竭患者短期死亡的独立预测因子

秦娇，强丽，陈文，吴刚   

  • 出版日期:2018-11-20 发布日期:2018-11-20

Red blood cell distribution width is a independent prognostic indicator for mortality in patients with HBV related acute-on-chronic liver failure

  • Online:2018-11-20 Published:2018-11-20

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摘要： 目的探讨红细胞分布宽度（RDW）在乙肝相关慢加急性肝衰竭(HBV-ACLF)患者短期死亡预测的应用价值，拟建立 MELD-RDW预测模型。方法回顾性收集我院245 名HBV-ACLF患者入院时临床症状及血常规、肝功能、肾功、凝血检验、 HBV-DNA等检验指标，通过单因素分析、二元Logistic 回归分析等方法检验HBV-ACLF 患者短期死亡的危险因素，建立 MELD-RDW预测模型，使用ROC曲线比较各个指标及建立的预测模型对于HBV-ACLF患者转归预测价值的准确性。结果 HBV-ACLF患者生存组的RDW（14.97±1.38），MELD评分（23.54±4.35）明显低于死亡组（17.05±2.92，28.95±5.99）；多变量分析 中，RDW是HBV-ACLF患者短期死亡的独立危险因素（OR=1.840，95%CI：1.479~2.289，P<0.005）；根据回归分析结果，建立 [logisticMELD-RDW]=-9.375+0.582×RDW-0.091×白蛋白-0.05×凝西酶原活动度+0.186×MELD预测模型，其ROC曲线下面积 为0.878，优于单独使用RDW（0.724）与终末期肝病模型（MELD）评分（0.780）的预测价值。结论RDW可作为HBV-ACLF患者 短期死亡的独立预测因子；与MELD评分相比，MELD-RDW模型对HBV-ACLF患者短期死亡预测价值更高。

Abstract: Objective To establish a model for predicting the short-term prognosis of patients with HBV-related acute-onchronic liver failure (HBV-ACLF) based on red blood cell distribution width (RDW) and the model for end-stage liver disease (MELD) scores. Methods A total of 245 patients with HBV-ACLF were retrospectively analyzed for their clinical data and results of routine hematological tests, liver function, renal function, coagulation test, HBV-DNA, and other indicators at admission. Univariate analysis and binary logistic regression analysis were used to test the short-term risk factors for death of the patients, and the MELD-RDW model was established. The accuracy of each index and the established model was verified using the ROC curve. Results The surviving patients with HBV-ACLF had significantly decreased RDW (14.97 ± 1.38) and MELD score (23.54±4.35) compared with those in the patients dead within 90 days (17.05±2.92 and 28.95±5.99, respectively). Multivariate analysis indicated that RDW was a significant independent prognostic factor for mortality in patients with HBVACLF (OR=1.840, 95%CI: 1.47902.289, P<0.005). The risk assessment model was [logisticMELD-RDW] =- 9.375 + 0.582 ×RDW- 0.091×ALB-0.05×PTA+0.186×MELD. The area under the ROC curve of MELD score combined with RDW was 0.878, which was higher than RDW (0.724) and MELD score (0.780) alone. Conclusion RDW is an independent prognostic indicator for mortality in patients with HBV-ACLF. Compared with MELD score, the risk assessment model based on MELD and RDW has a greater value in predicting the short-term prognosis of patients with HBV-ACLF.