LFI联合CTP评分对肝硬化患者肝病复合不良事件的预测价值

来源期刊：广州医药 | 945-950 发布时间：2025-08-28 收稿时间：2025/11/13 18:52:50 阅读量：31

作者：: 江晓艳,

黄颖欣,

黄靖晖,

关键词：: 肝硬化肝病复合不良事件肝脏衰弱指数肝功能分级危险因素; liver cirrhosis complex adverse events of liver disease Liver Frailty Index liver function grading risk factors

DOI：: 10.20223/j.cnki.1000-8535.2025.07.013

收稿时间：: 2024-06-17
修订日期：
接收日期：
引用总数：: 2

目的探讨肝脏衰弱程度联合肝功能分级预测肝硬化患者肝病复合不良事件的价值,作为识别和干预不良结局的依据。方法选择2022年12月—2023年12月医院接收的肝硬化患者80例进行研究,随访6个月观察患者不良事件发生情况,将出现2个及以上肝病并发症的肝病复合不良事件患者25例作为观察组,将出现1个肝病并发症或未出现并发症的患者55例作为对照组,比较两组患者的基本资料、实验室指标、营养指标、体力活动水平、肝脏衰弱指数（LFI）、肝功能Child-Turcotte-Pugh（CTP）评分,采用单因素和多因素Cox回归分析评估肝硬化患者肝病复合不良事件的危险因素,使用受试者工作特征（ROC）曲线下面积评估LFI联合CTP评分预测肝硬化患者肝病复合不良事件的价值。结果观察组年龄、丙氨酸氨基转移酶（ALT）高于对照组,红细胞计数（RBC）、血红蛋白（Hb）、血肌酐（Scr）、总胆红素（TBIL）、步速、小腿围低于对照组（t分别为4.235、6.500、3.826、3.989、4.289、8.878、2.474,均P<0.05）。观察组营养风险48.00%、LFI≥4.5分52.00%、CTP分级B/C级76.00%高于对照组18.18%、14.55%、27.27%（χ²分别为7.664、12.454、16.699,均P<0.05）。单因素Cox回归分析显示年龄、ALT、营养风险、LFI≥4.5分、CTP分级B/C级、RBC、Scr、TBIL、Hb、步速、小腿围为肝硬化患者发生肝病复合不良事件的危险因素（HR分别为2.251、1.578、1.626、1.981、1.715、1.428、1.443、1.419、1.336、1.332、1.254,均P<0.05）。多因素Cox回归分析显示年龄、营养风险、LFI≥4.5分、CTP分级B/C级为肝硬化患者发生肝病复合不良事件的独立危险因素（HR分别为2.275、1.746、2.025、1.895,P均<0.05）。ROC曲线结果显示LFI、CTP、LFI联合CTP预测肝硬化患者肝病复合不良事件的AUC分别为0.82、0.79、0.88（P<0.05）。结论年龄、肝脏衰弱、CTP分级B/C级、营养风险为肝硬化患者肝病复合不良事件的危险因素,肝脏衰弱程度联合肝功能分级预测肝硬化患者肝病复合不良事件具有更高的效能。

Objective To explore the value of predicting liver disease complex adverse events in patients with liver cirrhosis by combining the degree of liver frailty with liver function grading,as a basis for identifying and intervening in adverse outcomes．Methods A study was conducted on 80 patients with liver cirrhosis admitted to the hospital from December 2022 to December 2023． Patients were followed up for six months to observe the occurrence of adverse events．Twenty-five patients with liver disease complex adverse events with two or more liver disease complications were selected as the observation group,and 55 patients with one or no liver disease complication were selected as the control group．The basic information,laboratory indicators,nutritional indicators,physical activity levels,liver frailty index（LFI）,Child Turcotte Pugh（CTP）scores,univariate and multivariate Cox regression analysis were used to evaluate the risk factors for liver disease complex adverse events in liver cirrhosis patients．The value of combining LFI and CTP score in predicting liver disease complex adverse events in patients with liver cirrhosis was assessed by Receiver Operating Characteristic（ROC）curve area．Results The age,alanine aminotransferase（ALT）,red blood cell count（RBC）,hemoglobin（Hb）,serum creatinine（Scr）,total bilirubin（TBIL）,walking speed,and calf circumference of the observation group were higher than those of the control group（t=4.235,6.500,3.826,3.989,4.289,8.878,2.474,all P<0.05）．The nutritional risk of the observation group was 48.00%,LFI score≥4.5 was 52.00%,CTP grade B/C was 76.00%,which was higher than that of the control group at 18.18%,14.55%,and 27.27%（χ²=7.664,12.454,16.699,all P<0.05）．Univariate Cox regression analysis showed age,ALT,nutritional risk,LFI ≥ 4.5,CTP grade B/C,RBC,Scr,TBIL,Hb,step speed and calf circumference were risk factors for the occurrence of liver disease complex adverse events in patients with liver cirrhosis（HR values=2.251,1.578,1.626,1.981,1.715,1.428,1.443,1.419,1.336,1.332,1.254,all P<0.05）．Multivariate Cox regression analysis showed that age,nutritional risk,LFI ≥ 4.5,and CTP grade B/C were independent risk factors for liver disease complex adverse events in patients with liver cirrhosis（HR values=2.275,1.746,2.025,1.895,all P<0.05）．The ROC curve results showed that the AUC of LFI,CTP,and LFI combined with CTP in predicting liver disease composite adverse events in patients with liver cirrhosis were 0.82,0.79,and 0.88,respectively（P<0.05）．Conclusions Age,liver frailty,CTP grade B/C,and nutritional risk are risk factors for liver disease complex adverse events in patients with liver cirrhosis．The combination of LFI and liver function grade has higher efficacy in predicting liver disease complex adverse events in patients with liver cirrhosis．

1、陈健,钱建清,徐晓丹,等.改良CTP评分对肝硬化食管胃底静脉曲张破裂再出血的预测价值[J].中国医师杂志,2019,21(5):727-729.

2、张昕,刘丹阳,赵蕊.肝硬化消化道出血伴肝性脑病的危险因素分析[J].中西医结合肝病杂志,2022,32(10):895-898.

3、 ISHIKAWA T,ENDO S,IMAI M.Changes in the body composition and nutritional status after long-term rifaximin therapy for hyperammonemia in Japanese patients with hepatic encephalopathy[J].Intern Med,2020,59(20):2465-2469.

4、唐艳芳,刘旭东,王文鑫,等.肝硬化合并轻微型肝性脑病的临床特点以及相关影响因素分析[J].传染病信息,2022,35(4):316-320.

5、张家齐,王再超,杨家耀,等.慢性乙型肝炎肝硬化患者继发肝性脑病风险预测模型的构建与验证[J].肝脏,2023,28(8):916-920,931.

6、陈肖,郑晓媛,陈佳,等.基于倾向性评分匹配法评估卡维地洛对肝硬化腹腔积液伴食管胃底静脉曲张出血患者生存状况的影响[J].中国药业,2022,31(2):24-27.

7、赵勋念,杨杰.肝硬化患者营养不良风险筛查及评估方法的研究进展[J].临床内科杂志,2023,40(12):862-864.

8、李莉莉,何娜,邓淑敏,等.乙肝肝硬化住院患者衰弱风险预测模型的构建及验证[J].现代临床护理,2023,22(6):1-9.

9、卞兆连,邵建国,薛红.CONUT联合CTP评分预测肝硬化合并肝性脑病患者短期预后的临床意义[J].胃肠病学,2023,28(1):6-11.

10、李莉莉,周子惠,何娜,等.肝硬化病人衰弱评估的研究进展[J].护理研究,2022,36(17):3106-3110.

11、任艺,郭丽丽,李荣山.肝硬化患者死亡危险因素分析及列线图预测模型的建立[J].临床肾脏病杂志,2023,23(12):1017-1022.

12、 MüLLER L,HAHN F,M?HRINGER-KUNZ A.Immunonutritive scoring in patients with hepatocellular carcinoma undergoing transarterial chemoembolization:Prognostic nutritional index or controlling nutritional status score?[J].Front Oncol,2021(11):696183.

13、 MOON A M,SINGAL A G,TAPPER E B.Contemporary epidemiology of chronic liver disease and cirrhosis[J].2020,18(12):2650-2666.

14、张宇杰,杨永红,夏凤琼,等.肝硬化患者临床凝血功能检验中全自动血凝仪测定的应用及临床价值研究[J].广州医药,2021,52(5):69-72.

15、李凤惠,张旭,王涛,等.肝硬化患者TIPS术后死亡危险因素及不同评价系统的预测价值[J].国际生物医学工程杂志,2022,45(2):93-98,111.

16、彭喜春,孙艳.乙型病毒性肝炎不同状态合并2型糖尿病临床特征[J].广州医药,2022,53(2):7-11.

17、顾达,童聪,赵祥安,等.PC/SD、FIB-4指数、CTP评分、MELD评分、MELD-Na评分在预测肝硬化食管静脉曲张出血套扎术后1年内再出血的价值评估[J].胃肠病学和肝病学杂志,2023,32(3):289-294.

18、思蓓,凌颜,罗慧敏,等.基于营养风险评估的护理干预对肝硬化患者预后的影响[J].护理实践与研究,2023,20(2):172-175.

19、秦岚,叶艳欣,方庆虹,等.住院癌症患者衰弱风险预测模型的构建与验证[J].护理学杂志,2022,37(9):28-33.

20、刘正律,谢郭豪,方向明.肝硬化患者肝移植术前衰弱评估与预康复[J].国际麻醉学与复苏杂志,2021,42(8):864-868.

21、喻雪珂,黎孟玲,彭思远,等.食管胃底静脉曲张破裂出血对肝硬化患者1年死亡结局的影响及相关因素研究[J].中国全科医学,2023,26(14):1745-1752.

22、中华医学会肝病学分会.肝硬化诊治指南[J].中华肝脏病杂志,2019,27(11):846-865.

23、张洪文,官川博,荣亚梅,等.肝硬化伴急性上消化道出血的死亡相关危险因素分析和不同预后评分系统的对比[J].内科,2023,18(3):236-240.

24、李敏,苏健婷,武珊珊,等.乙型肝炎肝硬化患者年龄和性别与肝病相关死亡风险的关系[J].中华肝脏病杂志,2021,29(5):403-408.