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目的采用受试者工作特征(ROC)曲线确定原发性胆汁性肝硬化(PBC)患者生存预后诊断阈值并评价其临床意义。方法以2001年10月至2009年9月北京佑安医院收治的155例确诊PBC患者为研究对象,进行随访,随访终点事件为死亡和(或)进行肝移植。对患者临床资料进行分析,符合正态分布的定量资料采用独立样本t检验,偏态分布的定量资料采用Wilcoxon秩和检验;计数资料采用χ2检验;偏态分布定量资料或分类变量资料采用Spearman秩相关分析法。采用ROC曲线确定预后诊断指标及阈值,采用Kaplan-Meier法进行组间生存率,评价临床意义。结果随访中位时间为50个月(6~316个月),36例患者出现终点事件(33例患者死亡,3例患者进行了肝移植)。年龄≥55岁、TBil>1.8 mg/dl、血清总IgG>17.2 g/L、Mayo评分(MRS)>6.11对肝硬化阶段PBC患者具有预后诊断价值;4项指标作联合分析,串联的特异度可达99.18%,灵敏度为5.56%,总符合率为79.23%;并联时,其灵敏度可达100%,特异度为24.51%,总符合率为40.77%;对年龄≥55岁组,TBil>1.8 mg/dl组,IgG>17.2g/L组,MRS>6.11组分别与其对照组进行组间生存率比较,差异均有统计学意义(P<0.05)。结论年龄≥55岁、TBil>1.8 mg/dl、IgG>17.2 g/L、MRS>6.11可能对肝硬化阶段PBC患者生存预后具有预测价值。
Objective To determine the diagnostic value of survival prognosis in patients with primary biliary cirrhosis (PBC) using the receiver operating characteristic (ROC) curve and evaluate its clinical significance. Methods A total of 155 patients with confirmed PBC who were admitted to Beijing You’an Hospital from October 2001 to September 2009 were investigated. All the patients were followed up. The end point of follow-up was death and / or liver transplantation. The clinical data of patients were analyzed. The data of normal distribution were analyzed by independent sample t-test. The skewed distribution was analyzed by Wilcoxon rank-sum test. Chi-square test was used to count data. The skewed distribution of quantitative data or categorical data was analyzed by Spearman rank Correlation analysis. The ROC curve was used to determine the prognostic indicators and thresholds, and the Kaplan-Meier method was used to evaluate the clinical significance. Results The median follow-up time was 50 months (range, 6 to 316 months). Thirty-six patients had an end point event (33 patients died and 3 patients underwent liver transplantation). Age≥55 years, TBil> 1.8 mg / dl, serum total IgG> 17.2 g / L, Mayo score> 6.11, which had prognostic value in patients with PBC during the stage of liver cirrhosis. Four indicators were analyzed in combination, Up to 99.18%, the sensitivity was 5.56% and the total coincidence rate was 79.23%. In parallel, the sensitivity was 100%, the specificity was 24.51% and the total coincidence rate was 40.77% mg / dl group, IgG> 17.2g / L group and MRS> 6.11 group were compared with the control group respectively. The difference was statistically significant (P <0.05). Conclusions Age> 55 years, TBil> 1.8 mg / dl, IgG> 17.2 g / L and MRS> 6.11 may predict the prognosis of patients with PBC in cirrhosis.