摘要目的:探讨终末期肝病模型(MELD)评分联合血清凝血酶原时间(PT)、血清乳酸/肌酐比值评估肝功能衰竭患者人工肝预后的价值。方法:抽取2017年5月至2019年5月信阳市中心医院收治的181例肝功能衰竭患者，均接受人工肝治疗；根据住院3个月内预后情况分为预后良好组(121例)和预后较差组(60例)；比较两组患者MELD评分、PT、血清乳酸/肌酐比值；分析患者肝功能衰竭分期与MELD评分、PT、血清乳酸/肌酐比的相关性；分析MELD评分联合血清PT、血清乳酸/肌酐比值评估肝功能衰竭患者人工肝的预后价值。结果:与预后良好组比较，预后较差组MELD评分、血清PT、血清乳酸/肌酐比值更高( P<0.05)；与早期和中期肝功能衰竭患者比较，晚期患者MELD评分、血清PT、血清乳酸/肌酐比值更高；与早期肝功能衰竭患者比较，中期肝功能衰竭患者MELD评分、血清PT、血清乳酸/肌酐比值较高( P<0.05)。经相关性分析发现，MELD评分、血清PT、血清乳酸/肌酐比值与肝功能衰竭的恶性程度呈正相关；经分析发现，MELD评分联合血清PT、血清乳酸/肌酐检测的灵敏度与特异性均高于各项单独检测。 结论:MELD评分、血清PT、血清乳酸/肌酐比值与患者肝功能衰竭的病情程度呈正相关。MELD评分联合血清PT、血清乳酸/肌酐比值能够准确评估肝功能衰竭患者人工肝的预后。

abstractsObjective:To study the value of model for end-stage liver disease (MELD) score combined with serum prothrombin time (PT) and serum lactic acid/creatinine ratio in evaluating the prognosis of artificial liver in patients with liver failure.Methods:One hundred and eighty-one patients with liver failure admitted to Xinyang Central Hospital from May 2017 to May 2019 were enrolled and received artificial liver treatment. According to the prognosis within 3 months of hospitalization, they were divided into good prognosis group ( n=121) and poor prognosis group ( n=60). MELD score, serum PT, and serum lactic acid/creatinine ratio were compared between the two groups. Correlation analysis was performed between liver failure stages with MELD score, PT, and serum lactate/creatinine ratio. The prognostic value of MELD score combined with serum PT and serum lactate/creatinine ratio to evaluate the artificial liver in patients with liver failure was analyzed. Results:Compared with the good prognosis group, MELD score, serum PT, and serum lactic acid/creatinine ratio of the poor prognosis group were significantly higher ( P<0.05). Compared with patients with early and mid-stage liver failure, the MELD score, the serum PT and the serum lactic acid/creatinine ratio in the advanced patients were significantly higher. Compared with patients with early liver failure, MELD score, serum PT and serum lactic acid/creatinine ratio were significantly higher in patients with intermediate liver failure ( P<0.05). According to correlation analysis, MELD score, serum PT, serum lactic acid/creatinine ratio were positively correlated with the malignancy of liver failure. Analysis showed that the detection sensitivity and the specificity of MELD score combined with serum PT, serum lactic acid/creatinine are higher than the single one. Conclusions:MELD score, serum PT, and serum lactic acid/creatinine ratio are positively correlated with the degree of liver failure; their combination can accurately assess the prognosis of artificial liver in liver failure patients.