文章摘要
梁利民,徐鹤翔,郑吉顺,章媛媛.RDW、NLR联合MELD评分评估失代偿期肝硬化患者预后的临床价值[J].南京医科大学学报,2020,(2):217~222
RDW、NLR联合MELD评分评估失代偿期肝硬化患者预后的临床价值
The value of RDW and NLR combined with MELD score in predicting the prognosis of patients with decompensated cirrhosis
投稿时间:2019-02-13  
DOI:10.7655/NYDXBNS20200213
中文关键词: 肝硬化  红细胞分布宽度  中性粒细胞淋巴细胞比值  终末期肝病模型评分
英文关键词: liver cirrhosis  red blood cell distribution width  neutrophil to lymphocyte ratio  MELD score
基金项目:中国肝炎防治基金会天晴肝病研究基金(TQGB20180226);合肥市卫生计生委应用医学研究重点项目(hwk2016zd003)
作者单位
梁利民 安徽医科大学第三附属医院合肥市第一人民医院感染性疾病科 安徽 合肥 230001 
徐鹤翔 安徽医科大学第三附属医院合肥市第一人民医院感染性疾病科 安徽 合肥 230001 
郑吉顺 安徽医科大学第三附属医院合肥市第一人民医院感染性疾病科 安徽 合肥 230001 
章媛媛 安徽省中西医结合医院普外科 安徽 合肥 230061 
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中文摘要:
      目的:探讨红细胞分布宽度(red blood cell distribution width,RDW)、中性粒细胞淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)联合终末期肝病模型(model for end?stage liver disease,MELD)评分评估失代偿期肝硬化患者预后的价值。方法:回顾性分析2013年1月—2016年12月本院确诊的肝硬化失代偿期患者181例,以死亡为终点事件,根据患者随访1年的疾病转归情况分为生存组(n=126)和死亡组(n=55),比较两组患者入院时RDW、NLR、MELD水平差异,运用多因素Cox风险比例模型预测患者1年死亡的独立影响因素,绘制受试者工作特征(ROC)曲线,比较ROC曲线下面积(AUC),应用Kaplan?Meier曲线分析不同RDW、NLR患者的1年生存率变化。最后通过二分类变量Logistic回归对RDW、NLR、MELD评分进行联合,评估多变量联合预测患者1年死亡的价值。结果:181例随访1年死亡55例,存活126例,死亡组入院时NLR、RDW、MELD评分均高于生存组(P<0.05);多因素Cox回归分析后显示,NLR、RDW及MELD评分是预测患者1年死亡的独立危险因素;RDW、NLR及MELD评分预测患者1年预后最佳临界值分别为14.65%、2.58、16.65,ROC曲线下面积(AUC)分别为0.652、0.764、0.862;MELD评分联合NLR的AUC为0.870,MELD评分联合RDW的AUC为0.876,MELD、RDW、NLR三者联合的AUC提高至0.884。结论:MELD、RDW、NLR三者联合对失代偿期肝硬化患者1年预后有较高的预测价值,优于单独MELD评分。
英文摘要:
      Objective:This study aims to evaluate the value of combined red blood cell distribution width(RDW)and neutrophil to lymphocyte ratio(NLR),along with model for end?stage liver disease(MELD) scores for predicting prognosis in patients with decompensated cirrhosis. Methods:A retrospective study was conducted on 181 patients with decompensated cirrhosis during January 2013 to December 2016. With death as the end point event,the patients were divided into death group and survival group according to the outcome of 1 year of follow?up. The differences of RDW,NLR and MELD levels at admission between the two groups were compared. Using multivariate Cox risk proportional model to predict independent predictors of the occurrence of 1?year mortality. The receiver operating characteristic(ROC) curve was drawn,and the area under the ROC curve(AUC) was compared. Kaplan?Meier survival analysis was carried out to compare the 1 year survival rate of patients with different RDW and NLR values. Finally,RDW,NLR and MELD scores were combined by binary logistic regression to assess the value of multivariate combination in predicting death within one year. Results:In 181 cases of decompensated cirrhosis,55 died and 126 survived within 1 years of follow?up. The value of NLR,RDW and MELD scores in the death group were statistically higher than those in the survival group(P<0.05). Multivariate Cox regression analysis suggested that NLR,RDW and MELD score were independent risk factors for predicting one?year mortality. The optimal cut?off values were 14.65% for RDW,2.58 for NLR,16.65 for MELD,with the AUC were 0.652,0.764 and 0.862,respectively. For combined measurements,the AUC was 0.870 for MELD score plus NLR and 0.876 for MELD score plus RDW,was increased to 0.884 for combination of RWD,NLR and MELD score. Conclusion:The combination of MELD,RDW and NLR has a higher predictive value for the 1?year prognosis of decompensated cirrhosis than MELD alone.
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