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标题: 我们如何提高开始接受抗病毒治疗的HBV相关失代偿性肝硬化 [打印本页]

作者: StephenW 时间: 2018-2-22 14:02 标题: 我们如何提高开始接受抗病毒治疗的HBV相关失代偿性肝硬化

J Gastroenterol Hepatol. 2018 Feb 20. doi: 10.1111/jgh.14128. [Epub ahead of print]
How can we improve the performance of MELDNa score in patients with HBV-related decompensated liver cirrhosis commencing antiviral treatment?Kim TH1, Ku DH1, Um SH1, Lee HA1, Park SW1, Chang JM1, Yim SY1, Suh SJ1, Jung YK1, Seo YS1, Kim JH1, Yim HJ1, Yeon JE1, Byun KS1, Ahn H2.
Author information
1Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.2Department of Medical Statistics, Korea University College of Medicine, Seoul, Korea.

AbstractBACKGROUND AND AIM: We aimed to develop a more efficient prognostic model to predict 1-year mortality in patients with hepatitis B virus (HBV)-related decompensated cirrhosis beginning antiviral treatment.
METHODS: Using Cox regression analysis, survival analyses were performed on 554 patients with decompensated cirrhosis who were followed up from the start of nucleos(t)ide analogue antiviral treatment.
RESULTS: At baseline, ascites and hepatic encephalopathy were found in 78.0% and 18.1% of patients, respectively. Eighty-six events (77 deaths and 9 emergency liver transplants [LTs]) occurred within the first year of treatment. Severity of ascites, presence of hepatic encephalopathy, and the Model for End-Stage Liver Disease (MELD)-sodium (MELDNa) score were independent risk factors for 1-year mortality. The new prognostic model (the revised MELDNa [rMELDNa]) constructed by adding ascites and encephalopathy to the MELDNa score significantly improved the area under the receiver operating characteristics curve for predicting 1-year events at baseline compared with the Child-Turcotte-Pugh (CTP) system, MELD and MELDNa models, and Fontana index (0.905 vs. 0.867, 0.843, 0.871, and 0.815, respectively; P<0.05). Furthermore, repetitive application of rMELDNa at 0, 1, 2, 3, and 6 months of treatment could predict 81.4 % (70/86) of 1-year events, which was significantly (P<0.05) higher than the sensitivity of the CTP system (68.6%), MELD (70.9%) and MELDNa (68.6%) scores, and Fontana index (64.0%), achieving similar specificities of ~96%.
CONCLUSIONS: Ascites and encephalopathy should be considered together with the MELDNa score when predicting short-term mortality and planning LT in patients with decompensated HBV-related cirrhosis starting antiviral treatment.

KEYWORDS: Hepatitis B; Liver cirrhosis; Liver transplantation; Prognosis

PMID:29462844DOI:10.1111/jgh.14128

作者: StephenW 时间: 2018-2-22 14:02

J Gastroenterol Hepatol。 2018年2月20日。doi：10.1111 / jgh.14128。 [电子版提前打印]
我们如何提高开始接受抗病毒治疗的HBV相关失代偿性肝硬化患者的MELDNa评分？
Kim TH1 Ku DH1 Um SH1 Lee HA1 Park SW1 Chang JM1 Yim SY1 Suh SJ1 Jung YK1 Seo YS1 Kim JH1 Yim HJ1 Yeon JE1 Byun KS1 Ahn H2
作者信息

1
韩国首尔高丽大学医学院内科系。
2
韩国首尔韩国大学医学院医学统计系。

抽象
背景和目的：

我们的目标是开发更有效的预后模型来预测开始抗病毒治疗的乙型肝炎病毒（HBV）相关失代偿性肝硬化患者的1年死亡率。
方法：

使用Cox回归分析，对554例失代偿性肝硬化患者进行生存分析，随后从核苷（酸）类似物抗病毒治疗开始随访。
结果：

在基线时，分别有78.0％和18.1％的患者发现腹水和肝性脑病。治疗第一年发生了86次事件（77人死亡和9次紧急肝移植[LTs]）。腹水严重程度，肝性脑病的存在以及终末期肝病模型（MELD） - 钠（MELDNa）评分是1年死亡率的独立危险因素。通过将腹水和脑病加入MELDNa评分构建的新的预后模型（修订后的MELDNa [rMELDNa]）显着改善了接受者操作特征曲线下的区域，以预测基线1年事件与Child-Turcotte-Pugh（CTP ）系统，MELD和MELDNa模型以及Fontana指数（分别为0.905对0.867,0.843,0.871和0.815; P <0.05）。此外，在治疗0,1,2,3和6个月时重复应用rMELDNa可预测1年事件的81.4％（70/86），这比CTP的敏感性高得多（P <0.05）系统（68.6％），MELD（70.9％）和MELDNa（68.6％）得分，Fontana指数（64.0％），达到〜96％的相似特征。
结论：

在开始抗病毒治疗的HBV失代偿性肝硬化患者中预测短期死亡率和计划LT时应考虑腹水和脑病以及MELDNa评分。

本文受版权保护。版权所有。
关键词：

乙型肝炎;肝硬化;肝移植;预测

结论：
29462844
DOI：
10.1111 / jgh.14128

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