实用临床医药杂志2024，Vol.28Issue(17)：35-40,6.DOI:10.7619/jcmp.20241108
血清神经元特异性烯醇化酶等指标预测肝硬化合并显性肝性脑病患者预后的价值
Value of indicators including serum neuron-specific enolase in assessing prognosis of patients with cirrhosis complicated by overt hepatic encephalopathy
摘要
Abstract
Objective To investigate the predictive value of serum neuron-specific enolase(NSE),prognostic nutritional index(PNI)score,hepatic encephalopathy(HE)grading,and the integrated model for end-stage liver disease(iMELD)score in assessing the short-term(90-day)prognosis of patients with cirrhosis complicated by overt hepatic encephalopathy(HE).Methods A retrospective analysis was conducted on clinical data from 470 patients with cirrhosis and overt HE,and they were divided into survival group(n=359)and mortality group(n=111)based on their survival status 90 days after admission.The PNI and iMELD scores were calculated using patient de-mographics,blood routine tests,coagulation function,liver and renal function electrolyte levels,and serum NSE levels within 24 hours of admission,along with HE grading.Receiver operating character-istic(ROC)curves,multivariate Logistic regression analysis,and Kaplan-Meier survival curves were employed to evaluate influencing factors of short-term prognosis of patients with cirrhosis and overt HE.Results The mortality group exhibited significantly higher serum NSE levels,HE grades,and iMELD scores,while demonstrated lower PNI score compared to the survival group(P＜0.05).Mult-ivariate Logistic regression analysis identified serum NSE,PNI score,HE grade,and iMELD score as independent predictors of short-term prognosis.The areas under the curve(AUCs)for serum NSE,PNI score,HE grade,and iMELD score in predicting short-term prognosis were 0.727,0.717,0.721,and 0.728,respectively,with cut-off values of 12.23 ng/mL,34.05 ng/mL,and 39.26 points for serum NSE,PNI score,and iMELD score.A combined prediction model of four factors demonstrated the highest predictive performance,with an AUC of 0.919 and a cut-off value of 0.23.Kaplan-Meier survival analysis revealed that patients with combined score of serum NSE,PNI score,HE grade,and iMELD cut-off value＜0.23 had a significantly higher 90-day survival rate compared to those with cut-off value≥0.23(Log-Rank=265.567,P＜0.001).Conclusion Serum NSE,PNI score,HE grade,and iMELD score exhibit good value in predicting the short-term prognosis of pa-tients with cirrhosis and overt HE,with an even higher predictive value when used in combination.关键词
血清神经元特异性烯醇化酶/预后营养指数评分/Integrated终末期肝病模型/肝硬化/显性肝性脑病Key words
serum neuron specificity enolase/prognostic nutritional index score/integrated end-stage liver disease model/liver cirrhosis/overt hepatic encephalopathy分类
医药卫生引用本文复制引用
任轲,田李均,黄晓英,韩旭东,章颖..血清神经元特异性烯醇化酶等指标预测肝硬化合并显性肝性脑病患者预后的价值[J].实用临床医药杂志,2024,28(17):35-40,6.基金项目
北京肝胆相照公益基金会项目(iGandanF-1082022-RGG009) （iGandanF-1082022-RGG009）
江苏省南通市卫生健康委员会项目(MSZ2023047) （MSZ2023047）
江苏省南通市市级科技计划项目(MSZ20099) （MSZ20099）
