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目的:探讨妊娠期急性脂肪肝(AFLP)患者预后相关的危险因素,并建立预测模型。方法:回顾性分析93例中南大学湘雅医院和湘雅二医院收治的AFLP患者,通过单因素和多因素Logistic回归分析死亡预测因素,并建立预测模型,联合比值比及受试者工作特征曲线(ROC曲线)比较不同因子的预测价值。结果:单因素分析显示国际标准化比值(INR)、总胆红素(TBIL)、血肌酐(Scr)、血小板计数(PLT)以及出现肝性脑病是AFLP患者病死的独立危险因素。多因素分析联合各项危险因素,以肝性脑病和PLT建立AFLP预后预测模型,其预测效能为87.0%,灵敏度为81.8%,特异度为76.8%。结论:TBIL、INR、Scr增加,PLT减少及出现严重肝性脑病是AFLP患者死亡的独立危险因素;建立的AFLP预后预测模型具有较高的预测效能。
Objective: To investigate the prognosis-related risk factors of patients with acute fatty liver in pregnancy (AFLP) and to establish a predictive model. Methods: A retrospective analysis of 93 cases of AFLP patients treated by Xiangya Hospital and Xiangya Second Hospital of Central South University was conducted. Univariate and multivariate Logistic regression analysis was used to analyze the predictors of death and the predictive models were established. The odds ratio and the receiver operating characteristic curve (ROC curve) to compare the predictive value of different factors. Results: Univariate analysis showed that INR, TBIL, Scr, PLT and hepatic encephalopathy were independent risk factors for AFLP. Multivariate analysis combined with various risk factors, hepatic encephalopathy and PLT established AFLP prognosis prediction model, the predicted efficacy was 87.0%, the sensitivity was 81.8%, the specificity was 76.8%. CONCLUSIONS: Increased TBIL, INR, Scr, decreased PLT and severe hepatic encephalopathy are independent risk factors for mortality in AFLP patients. The established AFLP prognosis prediction model has high predictive power.