目的: 应用胆红素、国际标准化比率预测自身免疫性肝炎（autoimmune hepatitis,AIH）肝移植时机。方法: 选取从2018年1月―2022年10月在本院进行治疗的52名AIH作为研究对象进行回顾性队列研究,在皮质类固醇治疗起始日（D0）和治疗第三天（D3）记录基线国际标准化比率（international standardized ratio,INR）、开始使用类固醇后3天内INR的变化和3天内总胆红素的变化,计算急性重症自身免疫性肝炎的生存和预后因素评分（SURFASA）。通过受试者操作者特征曲线下面积（AUC）评估SURFASA在预测皮质类固醇治疗应答中的性能。结果: 52名患者中,38例（73.1%）患者对皮质类固醇有应答,10例（19.2%）接受了肝移植,4例（7.7%）死于感染性并发症。应答者的SURFASA评分[-4.40（-4.82,-3.82）]显著低于非应答者组[-1.83 （-2.37,-1.84）]。INR（D3）[OR=6.85;95%CI：2.23~7.06;P<0.001）]和SURFASA[OR=6.97;95%CI：1.59~30.46;P<0.001）]与皮质类固醇无应答独立相关。在预测治疗应答方面,SURFASA评分（AUC=0.96,95%CI：0.92~1.00）具有优异表现,评分高于-2.6的排除皮质类固醇应答的敏感性为85.7%,特异性为100%,PPV为100%,NPV为95%。结论: SURFASA评分在早期识别AIH患者对皮质类固醇无应答中具有最高的AUC,表明它可能作为快速评估肝移植的一种有价值的工具。
Abstract
Objective Application of bilirubin and international standardized ratio to predict the timing of liver transplantation in autoimmune hepatitis (AIH). Methods This was a retrospective cohort study conducted in our hospital from January 2018 to October 2022, and 52 AIH patients were selected as the research objects. The baseline international normalized ratio (INR), the change of INR and the change of total bilirubin within 3 days after starting corticosteroid treatment were recorded on the first day (D0) and the third day (D3) to calculate the SURFASA score. The performance of SURFASA in predicting the response to corticosteroid therapy was evaluated by the area under the operator characteristic curve (AUC) of subjects. Results Of the 52 patients, 38(73.1%) responded to corticosteroids, 10(19.2%) received liver transplantation, and 4(7.7%) died of infectious complications. SURFASA score of respondents[-4.40 (-4.82, -3.82)] was significantly lower than that of non-responders [-1.83 (-2.37, -1.84)]. INR (D3) [OR=6.85; 95%CI 2.23-7.06; P<0.001)] and SURFASA [OR=6.97; 95%CI 1.59-30.46; P<0.001) ] was independently related to corticosteroid unresponsiveness. SURFASA score (AUC=0.96, 95%CI 0.92-1.00) had excellent performance in predicting treatment response. The sensitivity, specificity, PPV and NPV of excluding corticosteroid response with a score higher than -2.6 were 85.7%, 100%, 100% and 95%, respectively. Conclusions SURFASA score has the highest AUC in early identification of unresponsiveness to corticosteroids in patients with AIH, indicating that it may be a valuable tool for rapid evaluation of liver transplantation.
关键词
胆红素 /
国际标准化比率 /
自身免疫性肝炎 /
肝移植
Key words
bilirubin /
international standardized ratio /
autoimmune hepatitis /
liver transplantation
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参考文献
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基金
陕西省卫生健康委员会科研项目“基于胆红素、国际标准化比率探讨自身免疫性肝炎肝移植时机的研究”（20214255）
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