MELD评分 I-FABP MDH1与终末期肝病合并CRE自发性腹膜炎患者病情转归相关性及预测意义

doi:10.3969/j.issn.1006-6233.2025.09.022

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摘要 目的: 探讨终末期肝病合并碳青霉烯类耐药肠杆菌目细菌(CRE)自发性腹膜炎(SBP)患者终末期肝病模型(MELD)评分、肠脂肪酸结合蛋白(I-FABP)、苹果酸脱氢酶1(MDH1)与病情转归的相关性,并分析其对病情转归的预测价值。方法: 选取2021年7月至2024年7月本院收治的205例终末期肝病合并CRE SBP患者,根据28d病情转归情况分为不良组、良好组。比较两组基线资料、MELD评分、I-FABP、MDH1。分析病情转归的独立相关影响因素,并建立4种模型,模型1为未校正肝细胞癌、顽固性腹水,模型2为未校正肝细胞癌、顽固性腹水、肝性脑病、腹水白细胞,模型3为未校正肝细胞癌、顽固性腹水、肝性脑病、腹水白细胞、腹水中性粒细胞,模型4为校正肝细胞癌、顽固性腹水、肝性脑病、腹水白细胞、腹水中性粒细胞;依据MELD评分、I-FABP、MDH1四分位数分组,并分析其与COX比例风险回归模型一致性;平滑曲线拟合分析MELD评分、I-FABP、MDH1与病情转归的相关性;基于模型4建立列线图预测模型,分析该模型对病情转归的预测价值并进行验证。结果: 不良组肝细胞癌、顽固性腹水、肝性脑病患者占比以及腹水白细胞、腹水中性粒细胞水平显著高于良好组(P<0.05);不良组MELD评分、I-FABP、MDH1显著高于良好组(P<0.05);在校正了肝细胞癌、顽固性腹水、肝性脑病、腹水白细胞、腹水中性粒细胞后,MELD评分、I-FABP、MDH1仍是病情转归的独立相关影响因素(P<0.05);将MELD评分、I-FABP、MDH1分层后对模型4进行敏感性分析,分层分析的结果与前述COX比例风险回归模型保持一致,提示研究结果较为稳定;平滑曲线拟合显示MELD评分、I-FABP、MDH1与病情转归呈正向的线性关系(P<0.05);模型1、2、3、4预测病情转归的AUC分别为0.717、0.749、0.861、0.942,且模型4的AUC显著大于模型1、2、3(P<0.05);列线图分析显示模型4的C-index为0.898,且列线图模型区分度及预测能力良好,该列线图模型在预测病情转归方面拥有良好的临床效用。结论: 终末期肝病合并CRE自发性腹膜炎患者的病情转归不良患者MELD评分与血清I-FABP、MDH1水平升高,其为病情转归的独立相关影响因素,且与病情转归呈正向的线性关系,基于MELD评分、I-FABP、MDH1建立列线图模型,该模型对病情转归的预测效能良好,且具有临床效用性。

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	肖滢
	张晶晶
	张建东
	刘琰

关键词 ：终末期肝病, 碳青霉烯类耐药肠杆菌目细菌, 自发性腹膜炎, 终末期肝病模型, 肠脂肪酸结合蛋白, 苹果酸脱氢酶1

Abstract：Objective: To investigate the correlation between the Model for End-stage Liver Disease (MELD) score, intestinal fatty acid binding protein (I-FABP), and malate dehydrogenase 1 (MDH1) in patients with end-stage liver disease (ESLD) complicated with carbapenem-resistant Enterobacteriaceae (CRE) spontaneous peritonitis (SBP), and to analyze their predictive value for disease outcome. Methods: A total of 205 patients with end-stage liver disease complicated with CRE SBP admitted to our hospital from July 2021 to July 2024 were selected. Based on the 28-day disease progression, they were categorized into poor outcome group and good outcome group.. Baseline data, MELD score, I-FABP, and MDH1 were compared between the two groups. The independent factors related to the disease outcome was analyzed, and four models were established: Model 1 for uncorrected hepatocellular carcinoma and refractory ascites, Model 2 for uncorrected hepatocellular carcinoma, refractory ascites, hepatic encephalopathy, and ascitic white blood cells, Model 3 for uncorrected hepatocellular carcinoma, refractory ascites, hepatic encephalopathy, ascitic white blood cells, and ascitic neutrophils, and Model 4 for corrected hepatocellular carcinoma, refractory ascites, hepatic encephalopathy, ascitic white blood cells, and ascitic neutrophils. According to the MELD score, I-FABP, and MDH1 quartile grouping, the consistency with the COX proportional hazards regression model was analyzed. Smooth curve fitting was used to analyze the correlation between MELD score, I-FABP, MDH1, and disease outcome. Based on model 4, a nomogram prediction model was established to analyze the predictive value of the model for disease outcomes and to validate it. Results: The proportions of patients with hepatocellular carcinoma, refractory ascites, and hepatic encephalopathy, as well as the levels of white blood cells and neutrophils in ascites, were significantly higher in the poor outcome group than in the good outcome group (P<0.05). The MELD score, I-FABP, and MDH1 in the poor group were significantly higher than those in the good group (P<0.05). After adjusting for hepatocellular carcinoma, refractory ascites, hepatic encephalopathy, ascitic white blood cells, and ascitic neutrophils, MELD score, I-FABP, and MDH1 remained independent factors associated with disease outcome (P<0.05). After stratifying the MELD score, I-FABP, and MDH1, a sensitivity analysis was conducted on model 4. The results of the stratified analysis were consistent with the aforementioned COX proportional hazards regression model, suggesting that the research results were relatively stable. Smooth curve fitting showed that MELD score, I-FABP, and MDH1 had a positive linear relationship with disease outcome (P<0.05). The AUCs of models 1, 2, 3, and 4 for predicting disease outcomes were 0.717, 0.749, 0.861, and 0.942, respectively, and the AUC of model 4 was significantly greater than that of models 1, 2, and 3 (P<0.05). The nomogram analysis showed that the C-index of model 4 was 0.898, and the nomogram model had good discrimination and predictive ability. This nomogram model had good clinical utility in predicting disease outcomes. Conclusion: Patients with end-stage liver disease complicated with CRE spontaneous peritonitis who have a poor prognosis have an increased MELD score and serum I-FABP and MDH1 levels, which are independent factors associated with poor prognosis and have a positive linear relationship with prognosis. Based on the MELD score, I-FABP, and MDH1, a nomogram model is established, which has good predictive performance and clinical utility for predicting the disease outcome.

Key words： End-stage liver disease Carbapenem-resistant Enterobacteriaceae Spontaneous peritonitis Model for End-stage Liver Disease Intestinal fatty acid binding protein Malate dehydrogenase 1

基金资助:河北省医学科学研究课题计划资助,(编号:20230670)

通讯作者: 刘琰

引用本文:

肖滢, 张晶晶, 张建东, 刘琰. MELD评分 I-FABP MDH1与终末期肝病合并CRE自发性腹膜炎患者病情转归相关性及预测意义[J]. 河北医学, 2025, 31(9): 1536-1543.
XIAO Ying, ZHANG Jingjing, ZHANG Jiandong, et al. Correlation and Predictive Significance of MELD Score I-FABP MDH1 and the Disease Outcome of Patients with End-Stage Liver Disease Complicated with CRE Spontaneous Peritonitis. HeBei Med, 2025, 31(9): 1536-1543.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.09.022 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I9/1536

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