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目的评估终末期肝病模型(MELD)评分联合血清维生素B12(VitB12)对乙肝相关慢加急性肝衰竭患者(ACHBLF)短期预后的预测价值。方法入选187例ACHBLF患者,根据随访3个月的存活情况分组。观察死亡组与存活组血清总胆红素(TBIL)、肌酐(Cr)、凝血酶原时间国际标准化比率(INR)、VitB12,并计算MELD评分。应用受试者工作特征曲线(ROC曲线)评价MELD评分联合血清VitB12对ACHBLF患者死亡的预测能力。结果死亡组血清TBIL、INR、VitB12及MELD评分值明显高于存活组(P<0.05),MELD评分联合血清VitB12对ACHBLF患者3个月预后评估的ROC曲线下面积(AUC)为0.813,>单独MELD评分的AUC 0.711和单独血清VitB12的AUC 0.628。结论 MELD评分联合血清VitB12对ACHBLF患者短期预后的预测具有更好的价值。
Objective To evaluate the predictive value of end-stage liver disease (MELD) score combined with serum vitamin B12 (VitB12) in the short-term prognosis of patients with chronic hepatitis B and acute liver failure (ACHBLF). Methods A total of 187 patients with ACHBLF were enrolled and divided into groups according to the follow-up of 3 months. The serum total bilirubin (TBIL), creatinine (Cr), the international normalized ratio of prothrombin time (INR) and VitB12 in the death group and the survival group were observed and the MELD score was calculated. The receiver operating characteristic curve (ROC curve) was used to evaluate the predictive ability of MELD score combined with serum VitB12 in the death of ACHBLF patients. Results Serum levels of TBIL, INR, VitB12 and MELD in death group were significantly higher than those in survival group (P <0.05). The area under the curve of ROC curve (AUC) was 0.813 for MELD score combined with serum VitB12 for 3-month prognosis evaluation of ACHBLF patients. AUC 0.711 for MELD score and AUC 0.628 for serum VitB12 alone. Conclusion MELD score combined with serum VitB12 has a better value in predicting the short-term prognosis of patients with ACHBLF.