Zoli M, Cordiani M R, Marchesini G, Iervese T, Labate A M, Bonazzi C, Bianchi G, Pisi E
Istituti di Clinica Medica Generale e Terapia Medica, University of Bologna, Italy.
Am J Gastroenterol. 1991 Oct;86(10):1508-13.
In an attempt to identify variables predicting prognosis, 100 consecutive patients with compensated cirrhosis of the liver were followed for a mean of 4.9 (SD 0.7) yr. Fifty-one patients belonged to Child-Pugh class A, 49 to class B. At entry, five laboratory parameters were considered, together with sex, the grade of esophageal varices, and seven variables measured by ultrasonography (liver and spleen volume and the calibers of the splanchnic vessels). In a subgroup of 56 patients, the galactose elimination capacity also was determined. Forty-six patients were alive at the end of follow-up. Survival was analyzed according to Cox's model. Six parameters were able to predict survival (albumin, bilirubin, liver volume, prothrombin activity, cholesterol, varices). However, step-wise Cox regression analysis identified only four variables that independently correlated with survival: albumin, bilirubin, cholesterol, and liver volume. Galactose elimination failed to add any significance to routine liver function tests. This prospective study confirms the ability of routine liver function tests in predicting survival in compensated cirrhosis. The measurement of liver volume, easily obtained by ultrasonography, is also significant for prognosis, and may be introduced into clinical practice.
为了确定预测预后的变量,对100例连续性肝硬化代偿期患者进行了平均4.9(标准差0.7)年的随访。51例患者属于Child-Pugh A级,49例属于B级。入组时,考虑了5项实验室指标,以及性别、食管静脉曲张程度和7项通过超声测量的变量(肝脏和脾脏体积以及内脏血管内径)。在56例患者的亚组中,还测定了半乳糖清除能力。随访结束时46例患者存活。根据Cox模型分析生存率。6项指标能够预测生存(白蛋白、胆红素、肝脏体积、凝血酶原活性、胆固醇、静脉曲张)。然而,逐步Cox回归分析仅确定了4个与生存独立相关的变量:白蛋白、胆红素、胆固醇和肝脏体积。半乳糖清除能力对常规肝功能检查没有任何额外意义。这项前瞻性研究证实了常规肝功能检查预测肝硬化代偿期患者生存的能力。通过超声容易获得的肝脏体积测量对预后也有意义,可引入临床实践。