Yoneyama K, Taniguchi H, Kiuchi Y, Shibata M, Mitamura K
Health Service Center, Showa University, Tokyo, Japan.
Scand J Gastroenterol. 2004 Dec;39(12):1272-9. doi: 10.1080/00365520410008042.
In Japan, the incidence of liver cirrhosis caused by hepatitis viruses is higher, and cirrhosis is more likely to be complicated by hepatocellular carcinoma, than in Western countries. The aim of this study was to predict the outcome in liver cirrhosis with ascites with and without hepatocellular carcinoma.
The subjects were 146 patients with liver cirrhosis complicated by ascites. Forty-six factors were evaluated concerning clinical laboratory parameters and extracted prognostic factors using the Cox proportional hazards model.
The mean duration of the follow-up period was 634.9 days, during which 89 (61%) of the patients died, 27 (18.5%) survived, and 30 (20.6%) were lost to follow-up. The cumulative survival rate after the onset of ascites was 59.7% after 1 year, 44.5% after 2 years, and 29.5% after 5 years. Multivariate analysis indicated 9 factors, i.e. age, total bilirubin (T-Bil), alkaline phosphatase (ALP), blood urea nitrogen (BUN), alpha-fetoprotein (AFP), mean arterial pressure (MAP), gastrointestinal bleeding, infection, and portal vein tumor thrombosis (PVTT), as independent prognostic factors. The prognostic index (PI) was calculated by the following formula using these 9 factors. PI = 0.045 x age + 0.180 x T-Bil + 0.088 x ALP + 0.020 x BUN + 0.467 x AFP + (-0.022 x MAP) + 0.662 x gastrointestinal bleeding + 0.521 x infections + 0.882 x PVTT.
Prediction of the outcome using PI based on the 9 factors provides additional information for the determination of the therapeutic approach in cirrhotic patients with ascites with and without hepatocellular carcinoma.
在日本，与西方国家相比，由肝炎病毒引起的肝硬化发病率更高，且肝硬化更易并发肝细胞癌。本研究的目的是预测伴有或不伴有肝细胞癌的肝硬化腹水患者的预后。
研究对象为146例肝硬化并发腹水的患者。对46项临床实验室参数进行评估，并使用Cox比例风险模型提取预后因素。
随访期平均时长为634.9天，在此期间，89例（61%）患者死亡，27例（18.5%）存活，30例（20.6%）失访。腹水出现后的累积生存率1年后为59.7%，2年后为44.5%，5年后为29.5%。多因素分析表明，年龄、总胆红素（T-Bil）、碱性磷酸酶（ALP）、血尿素氮（BUN）、甲胎蛋白（AFP）、平均动脉压（MAP）、胃肠道出血、感染和门静脉肿瘤血栓形成（PVTT）这9个因素为独立预后因素。使用这9个因素通过以下公式计算预后指数（PI）。PI = 0.045×年龄 + 0.180×总胆红素 + 0.088×碱性磷酸酶 + 0.020×血尿素氮 + 0.467×甲胎蛋白 + (-0.022×平均动脉压) + 0.662×胃肠道出血 + 0.521×感染 + 0.882×门静脉肿瘤血栓形成。
基于这9个因素使用PI预测预后，可为伴有或不伴有肝细胞癌的肝硬化腹水患者治疗方法的确定提供额外信息。
