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非胆汁性肝实质肝硬化患者一年生存率的影响因素

Factors influencing survival at one year in patients with nonbiliary hepatic parenchymal cirrhosis.

作者信息

Adler M, Van Laethem J, Glibert A, Gelin M, Bourgeois N, Vereerstraeten P, Cremer M

机构信息

Medical-surgical Department of Gastroenterology, Hôpital Erasme, Brussels, Belgium.

出版信息

Dig Dis Sci. 1990 Jan;35(1):1-5. doi: 10.1007/BF01537214.

DOI:10.1007/BF01537214
PMID:2295285
Abstract

Transplantation may be considered for patients with advanced cirrhosis, however, adequate criteria for evaluating survival in those patients are ill-defined. The aim of the present study was to select, among several clinical and functional variables those that could best predict survival at one year. The data collected from 91 consecutive patients with parenchymal cirrhosis hospitalized in our center from February 1984 to January 1986 were subjected to stepwise logistic regression analysis. Death occurring during the first year following entry into the study was considered as a failure. During that period, there were no censored patients. Of 19 variables that entered into the analysis, only two were significant (P less than 0.01): presence (1: moderate; 2: severe) or absence (0) of ascites (A) and breath test (BT: % aminopyrine activity of administered dose at 2 hr). The logistic equation was: 1n (P/1 - P): - 1.95 A + 1.64 BT - 0.393, where P represented the probability of survival at one year. For each patient, P was calculated according to his A and BT values. Using a 0.7 probability cut-point to separate success from failure, 93% (70/75) of successes, 81% (13/16) of failures, and 91% (83/91) of both successes and failures could be correctly predicted. Predictive equations like the present preliminary one can be used in the future to better assess the risk of mortality in patients with parenchymal cirrhosis in whom liver transplantation is considered.

摘要

对于晚期肝硬化患者可考虑进行肝移植,然而,评估这些患者生存情况的适当标准尚不明确。本研究的目的是在多个临床和功能变量中选择最能预测一年生存率的变量。对1984年2月至1986年1月在我们中心住院的91例连续性实质性肝硬化患者收集的数据进行逐步逻辑回归分析。将进入研究后第一年内发生的死亡视为失败。在此期间,没有失访患者。在进入分析的19个变量中,只有两个具有显著性(P<0.01):腹水的有无(A:1:中度;2:重度;0:无)和呼气试验(BT:给药后2小时氨基比林活性百分比)。逻辑方程为:ln(P/1-P)=-1.95A+1.64BT-0.393,其中P代表一年生存率。根据每位患者的A和BT值计算P。使用0.7的概率切点区分成功与失败,成功组中93%(70/75)、失败组中81%(13/16)以及成功和失败两组中91%(83/91)可被正确预测。像目前这个初步方程这样的预测方程未来可用于更好地评估考虑进行肝移植的实质性肝硬化患者的死亡风险。

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A comparison of Child-Pugh, APACHE II and APACHE III scoring systems in predicting hospital mortality of patients with liver cirrhosis.Child-Pugh、APACHE II和APACHE III评分系统在预测肝硬化患者医院死亡率方面的比较。
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本文引用的文献

1
Aminopyrine N-demethylation: a prognostic test of liver function in patients with alcoholic liver disease.氨基比林N-去甲基化:酒精性肝病患者肝功能的一项预后检测
Gastroenterology. 1980 Dec;79(6):1145-50.
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Aminopyrine breath test predicts surgical risk for patients with liver disease.氨基比林呼吸试验可预测肝病患者的手术风险。
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Assessment of prognostic factors in alcoholic liver disease: toward a global quantitative expression of severity.酒精性肝病预后因素评估:迈向严重程度的全球定量表达。
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4
Caffeine clearance by enzyme multiplied immunoassay technique: a simple, inexpensive, and useful indicator of liver function.酶倍增免疫分析技术测定咖啡因清除率:一种简单、廉价且有用的肝功能指标。
Gut. 1991 Jun;32(6):681-4. doi: 10.1136/gut.32.6.681.
5
Prognostic value of galactose elimination capacity, aminopyrine breath test, and ICG clearance in patients with cirrhosis. Comparison with the Pugh score.肝硬化患者中半乳糖清除能力、氨基比林呼气试验和吲哚菁绿清除率的预后价值。与Pugh评分的比较。
Dig Dis Sci. 1991 Sep;36(9):1197-203. doi: 10.1007/BF01307508.
6
Aminopyrine breath test in the prognostic evaluation of patients with cirrhosis.氨基比林呼气试验在肝硬化患者预后评估中的应用
Gut. 1992 Jun;33(6):836-42. doi: 10.1136/gut.33.6.836.
Hepatology. 1983 Nov-Dec;3(6):896-905. doi: 10.1002/hep.1840030602.
4
Medical aspects of liver transplantation.肝移植的医学方面。
Hepatology. 1984 Jan-Feb;4(1 Suppl):79S-83S. doi: 10.1002/hep.1840040721.
5
Prognostic factors in cirrhosis identified by Cox's regression model.通过Cox回归模型确定的肝硬化预后因素。
Hepatology. 1983 Nov-Dec;3(6):889-95. doi: 10.1002/hep.1840030601.
6
Evaluation of survival data and two new rank order statistics arising in its consideration.生存数据的评估以及在考虑过程中出现的两个新的排序统计量。
Cancer Chemother Rep. 1966 Mar;50(3):163-70.
7
[14C]Aminopyrine breath analysis and conventional biochemical tests as predictors of survival in cirrhosis.
Dig Dis Sci. 1985 Sep;30(9):813-8. doi: 10.1007/BF01309509.
8
Prognostic evaluation in alcoholic cirrhosis.酒精性肝硬化的预后评估
Acta Med Scand Suppl. 1985;703:149-56. doi: 10.1111/j.0954-6820.1985.tb08912.x.
9
Prognostic value of the aminopyrine breath test in cirrhotic patients.氨基比林呼吸试验在肝硬化患者中的预后价值。
Hepatology. 1986 Sep-Oct;6(5):928-31. doi: 10.1002/hep.1840060520.
10
[Multidimensional analysis by Cox's model of the survival of patients with alcoholic cirrhosis].
Gastroenterol Clin Biol. 1986 Jun-Jul;10(6-7):461-7.