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目的 探讨早期动脉血乳酸水平对慢性肝衰竭(CLF)患者预后的评估价值.方法 对收住本院的76例慢性肝功能衰竭患者进行回顾性临床研究,测定入院时(0 h)及12 h动脉血乳酸水平,并对患者进行终末期肝病模型评价系统(MELD)评分,分析早期动脉血乳酸水平、MELD评分和患者28 d病死率的关系.结果 本次研究中,28 d病死率为43.4%.死亡组患者0、12 h动脉血乳酸水平明显高于生存组,差异有统计学意义(P<0.05);总胆汁酸及肌酐高于生存组,差异有统计学意义(P0.05).Logistic回归分析显示0、12 h动脉血乳酸值是慢性肝功能衰竭患者死亡的独立影响因素.患者入院时(0 h)动脉血乳酸水平的ROC曲线下面积为0.958,以6.85 mmol/L为最优截断点,0 h动脉血乳酸水平预测慢性肝衰竭患者入院后28 d死亡的灵敏度为93.9%,特异度为93.0%;12 h动脉血乳酸水平的ROC曲线下面积为0.991,以5.05 mmol/L为最优截断点,12 h动脉血乳酸水平预测慢性肝衰竭患者入院后28 d死亡的灵敏度为93.9%,特异度为97.7%;而MELD评分的ROC曲线下面积仅为0.446,无临床意义.结论 对于慢性肝功能衰竭患者,早期动态监测动脉血乳酸水平具有重要意义,可将0、12 h动脉血乳酸水平作为评估慢性肝功能衰竭患者预后的依据,其评估价值高于MELD评分系统.“,”Objective To evaluate the predictive value of early blood lactate in prognosis of chronic liver failure(CLF). Methods 76 chronic liver failure patients were investigated prospectively. Levels of blood lactate at 0 h and 12 h were measured,and model for end-stage liver disease(MELD)score were proceeded. Relationship between level of early blood lactate ,MELD score and the 28-day mortality were analyzed . Results The 28-day mortality was 43.4%. Levels of blood lactate in death group at 0 h and 12 h were obvious higher than those of survival group;the difference was statistically significant(P<0.05). Total bile acid and creatinine levels were higher than those in survival group;the difference was statistically significant(P0.05). Multivariate Logistic regression analysis showed that the blood lactate levels at 0 h and 12 h were independent predictive factors of prognosis evaluation. The curve of ROC showed a threshold level of lactate at 0 h was 6.85 mmol/L ,with 93.9% sensitivity and 93.0% specificity and the area under the ROC curve was 0.958. The curve of ROC showed a threshold level of lactate at 12 h was 5.05 mmol/L ,with 93.9% sensitivity and 97.7% specificity and the area under the ROC curve was 0.991.The area under the ROC curve of MELD score was 0.446 , without clinic significance. Conclusion Dynamic observation of lactate concentration provides the predictive value of prognosis for patients with chronic liver failure. Level of blood lactate at 0 h and 12 h had practical clinical value for the patients.