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目的探讨血浆渗透压评分对肝肾综合征(hepatorenal syndrome HRS)预后的评价作用。方法研究对象为106例HRS患者,按随访3月内的预后情况分为存活组(30例)和死亡组(76例),分别进行血浆有效晶体渗透压评分、胶体渗透压评分、血浆渗透压综合评分、终末期肝病模型(model for end-stage liver disease MELD)评分和Child-Pugh评分,进行统计学分析,比较各评分对HRS预后的评价能力。结果 除血浆有效晶体渗透压评分外,HRS死亡组的其余各评分均显著高于存活组(P<0.01)。Child-Pugh、MELD和血浆渗透压综合评分的曲线下面积(area under curve AUC)均>0.7,其余各项评分的AUC均<0.7。Youden指数以血浆渗透压综合评分为最高,MELD和Child-Pugh评分次之。结论 Child-Pugh、MELD和血浆渗透压综合评分对HRS预后均具有良好的评价作用,其中以血浆渗透压综合评分的预测能力最佳。
Objective To investigate the evaluation of the plasma osmotic pressure score on the prognosis of hepatorenal syndrome (HRS). Methods 106 cases of HRS patients were divided into survival group (n = 30) and death group (n = 76) according to the follow-up within 3 months. The effective plasma osmotic pressure score, colloid osmotic pressure score and plasma osmotic pressure Comprehensive score, model of end-stage liver disease (MELD) and Child-Pugh score were calculated and compared. All the scores were evaluated on the prognosis of HRS. Results The remaining scores of HRS death group were significantly higher than those of survival group (P <0.01) except for the effective plasma osmotic pressure score. The area under curve (AUC) of Child-Pugh, MELD and plasma osmolality were> 0.7, and the AUCs of other scores were all <0.7. Youden index with the highest comprehensive score of plasma osmolality, MELD and Child-Pugh score second. Conclusion The comprehensive scores of Child-Pugh, MELD and plasma osmolality have a good evaluation on the prognosis of HRS, and the comprehensive predictive value of plasma osmotic pressure is the best.