外文翻译-- Prognostic Model for the Patients with Severe.PDF外文翻译-- Prognostic Model for the Patients with Severe.PDF

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PROGNOSTICMODELFORTHEPATIENTSWITHSEVERELIVERDISEASEWENFANGWU1,JINGZHANG,BINRONGMA,JINQIUHE,LUNLIZHANG,CHUNYIZOU,SHAOJIEXIN,CHANGYANLIN1DEPARTMENTOFBIOLOGYMEDICALENGINEERINGCAPITALMEDICALUNIVERSITY,100069BEIJING,CHINAWUWENFANG99718YAHOOCOMCNBEIJINGANZHENHOSPITALBEIJING,CHINAABSTRACTTOANALYZEPROGNOSTICFACTORSOFPATIENTSWITHSEVERELIVERDISEASEANDDEVELOPAPROGNOSTICMODELFORTHEMWHICHISFITFULTOTHECHARACTERISTICSOFOURCOUNTRYFROMMARCH2002TOJUNE2007,THE527PATIENTSWITHSEVERELIVERDISEASEWEREEVALUATED,THEFOLLOWUPINFORMATIONWERECOLLECTEDINCLUDETHESURVIVALSTATEDEATH/SURVIVALTHESURVIVALMODELWASESTABLISHEDBYUSINGCOXPROPORTIONALHAZARDMODELNEW400CASESWEREUSEDTOTESTANDEVALUATETHEDECISIONCAPABILITYOFTHEMODELNINEPROGNOSTICFACTORSWEREEXTRACTEDBYUSINGCOX,THEPROGNOSTICINDEXPIWASCALCULATEDBYSTATISTICSANALYZETOCOMPARETHEROCAREAAUCOFTHISSYSTEMMODELWITHCTPANDMELD,THISSYSTEMMELDISBETTERTHANCTPANDMELDTHEDEVELOPEDMODELISFITFULTOTHECHARACTERISTICSOFOURCOUNTRYWHERETHEREAREALOTOFVIRUSHEPATITISPATIENTS,SOTHEMODELISVALUABLEINPROGNOSTICEVALUATIONOFSEVERELIVERPATIENTSANDVERYUSEFULTOGUIDECLINICIANSINSELECTINGTREATMENTMETHODSINCHINAKEYWORDSSEVERELIVERDISEASE;PROGNOSIS;COX′SPROPORTIONALHAZARDMODELIINTRODUCTIONHEPATITISISAMAJORDISEASEINCHINATHEDEATHRATEISABOUT70FORSEVEREHEPATITISTHERESULTSFROMTHEINTERNALMEDICALTHERAPYAREHARDTOBESATISFACTORYWITHRAPIDDEVELOPMENTOFSCIENCEANDTECHNOLOGYINRECENTLYYEARS,ARTIFICIALLIVERHASBEENBECOMINGANIMPORTANTCUREMETHODANDHASBEENUSEDBYTHEHOSPITALSATDIFFERENTLEVELSTHEMATURATIONOFLIVERTRANSPLANTATIONTECHNIQUEMAKESITONEOFTHEMOSTEFFECTIVETHERAPIESFORTHEPEOPLEATTHEFINALSTAGESOFTHELIVERDISEASEHOWEVER,BECAUSEOFTHELIMITATIONOFLIVERSOURCEANDTHEHIGHEXPENSEFORTHETREATMENT,MOSTOFTHESUFFERERSCANNOTBENEFITFROMITTHEREFORE,ITISTHECOMMONCONCERNFORTHESUFFERERSANDPERSONSWORKINGONTHELIVERDISEASETOCHOOSEPROPERTREATMENTMETHODWITHTHEWELLTIME,SOASTOIMPROVETHESURVIVALRATEANDTHEIRLIFEQUALITYTHEKEYTOSOLVETHISPROBLEMISTHEPROGNOSISWITHHIGHPRECISIONANDPROPEREVALUATIONOFTHEDISEASEANDITSTHERAPYFORYEARS,MULTIPLERESEARCHESHAVEBEENCONDUCTEDFORPROGNOSISJUDGMENTOFTHELIVERDISEASETHEMOSTSIGNIFICANTARETHECHILDTURCOTTEPUGH(CTP)CLASSIFICATIONANDMODELFORENDSTAGELIVERDISEASEMELD,WHICHHAVEBEENWIDELYUSEDTOPROGNOSISOFTHEFINALSTAGEOFLIVERDISEASE,ESP,THEHEPATOCIRRHOSIS,ANDHAVEBEENTHEBASISOFTHELIVERDISTRIBUTIONFORITSTRANSPLANTATIONHOWEVER,VIRUSISTHEMAINREASONFORTHELIVERDISEASEINOURCOUNTRYTHEHIGHOCCURRINGRATEOFHEPATOCIRRHOSISFROMTHEHEPATITISANDCHRONICSEVEREHEPATITISISDIFFERENTFROMITSACUTEBREAKOUTINABROADTHEREFORE,THEPROGNOSISSYSTEMFROMOTHERCOUNTRIESISNOTALWAYSAPPLICABLETOOURCOUNTRYTHERESEARCHERSINOURCOUNTRYARETRYINGTOFINDOUTTHEPROGNOSISGUIDELINETHATISSUITABLETOTHESITUATIONOFOURCOUNTRY,TOCONSTRUCTTHEPROGNOSISSYSTEMFORTHESUFFERERSOFLIVERDISEASES,ESP,FORTHEVIRUSHEPATITISHOWEVER,THEREHAVEBEENNOREPORTOFTHESTUDYWITHBIGSAMPLE,MULTIPLECENTERS,ANDWITHLONGTIMESURVIVINGANALYSISBASEDONTHEFOLLOWUPSURVEYⅡDATAANDMETHODSACASECHOICESACCORDINGTOPREVENTIONANDCUREPROJECTOFTHEHEPATITIS2000,527CASES,AGEDFROM1475,AREDIAGNOSEDASHEPATITISANDHEPATOCIRRHOSISFROMMARCH2002TOJUNE2007THESECASESCAMEFROMFIVEHOSPITALSINCLUDINGTHEBEIJINGYOUANHOSPITALAFFILIATEDTOCAPITALUNIVERSITYOFMEDICALSCIENCES,THENINTHPEOPLE’SHOSPITALOFNANCHANGINJIANGXIPROVINCE,THEFIRSTHOSPITALAFFILIATEDTOTHEJIANGXIMEDICINEUNIVERSITY,THESIXTHPEOPLE’SHOSPITALOFDALIANINLIAONINGPROVINCEANDTHEPROJECTNAMEWUJIEPINGMEDICALFOUNDATION320675009071,THECAPITALFUNDOFMEDICALRESEARCHANDDEVELOPMENT(20022039)9781424447138/10/25002010IEEE302HOSPITALOFTHECHINESEPEOPLEARMYBRECORDINGINDICES241INTOTALZNORMALINDICESSEX,AGE,DIAGNOSTICCLASSIFICATION,DIAGNOSTICSTAGES,PATHOGENY,COMPLICATIONS,RETURNAFTERLEAVINGHOSPITAL,INDUCEMENTOFDISEASE,ETCZCOMPLICATIONSTHEINFORMATIONOFASCITICFLUID,HCD,HRS,ALIMENTARYTRACTHEMORRHAGE,PLEURALEFFUSION,SPONTANEOUSPERITONITIS,DISTURBANCEOFACIDBASEBALANCEANDOTHERCOMPLICATIONSZLABORATORYANDMEDICALIMAGINGINDICESLIVERFUNCTIONALANDBIOCHEMICALINDICES,BLOODROUTINEEXAMINATIONINDICES,BLOODCOAGULATINGINDICES,PATHOGENINDICES;ANDIMAGINGINDICESCANALYSISMETHODSANDSTATISTICALMETHODSSURVIVINGSTATUSALIVEORDEADOFTHESUFFERERWASRECORDEDTHECURRENTBODYSTATUSLIVERTRANSPLANTATION,HEPATOCIRRHOSIS,CHRONICHEPATITIS,ANDHEALTHETCWERERECORDEDFORTHEALIVE,WHILETHETIMEDAYSINPRECISIONANDTHEREASONLIVERDISEASEORNOT,TOEXCLUDETHEDEATHFROMOTHERDISEASEFORTHEDEATHWERERECORDEDADATABASEWASCONSTRUCTEDWITHEPIDATA302BASEDONALLTHESEMATERIALS,INCLUDINGALLTHEINDICESRECORDEDANDRESULTSFROMTHEFOLLOWUPVISITINGTHECOXPROPORTIONALHAZARDSREGRESSIONANALYSISBUILTINSPSS130WASAPPLIEDTOTHEDATATHEREGRESSIONEQUATIONSWERECREATEDFROMTHEGROUPOFTHEINDICESWHICHCANREFLECTTHEPROGNOSISOFTHESEVEREHEPATITISSTATISTICALSIGNIFICANCEWASDEFINEDASP005ⅢRESULTSARESULTSOFSTATISTICALANALYSIS1THEMAININDICESOFTHEROUTINEEXAMINATIONADISTRIBUTIONOFETIOLOGICALAGENTSINTHESELECTEDSUFFERERSINTHESELECTED527CASES,611AREHEPATITISI;406770AREHEPATITISII;204AREHEPATITISIII;2649AREHEPATITISV;56106AREMIXED;408AREDRUGRELATED;408AREALCOHOLRELATED;102ISSELFIMMUNERELATED;AND2242AREFROMOTHERSOURCEBDIAGNOSISOFTHESELECTEDCASESINTHE527SELECTEDCASES,3974CASESAREACUTESEVEREHEPATITIS,5197ARESUBACUTESEVEREHEPATITIS,CHRONICSEVEREHEPATITISARE405769,ANDCHRONICHEPATITIS(TRENDINGTOSEVERE)ARE3260CALIMENTARYTRACTHEMORRHAGEWHENDIAGNOSEDWHENDIAGNOSED,NOBLEEDINGINTHEALIMENTARYCANALWASFOUNDIN433CASES822,WHILETHEOTHER94CASES178WEREFOUNDBLEEDINGDASCITESWHENDIAGNOSEDINTHESELECTED527CASES,255484HAVENOASCITES,124235CASESHAVESMALLAMOUNTOFASCITES,83157MIDDLEAMOUNT,AND65123CASESHAVELARGEAMOUNT2STATISTICALRESULTSOFAUXILIARYEXANIMATIONOFTHE527SELECTEDCASES,THEMAININDICESFROMTHELABORATORYANDMEDICALIMAGINGEXAMINATIONARESHOWNINTABLE1TABLE1VARIABLEINFORMATIONOFAUXILIARYEXANIMATIONVARIABLMMMSALTU/L2951ASTU/L2951AST/A10TBILM0520DBIL420D/T0ALBG/2330CHOM1640CRMG/10PTS2530INR0210PTA00NOTEALLVALUESISNATURALLOGARITHMINTHETABLE3SURVIVALOFTHESUFFERERSTABLE2SHOWSTHESURVIVALINFORMATIONOFTHE527PATIENTSBSCREENINGOFTHEINDEPENDENTPROGNOSTICFACTORSFIFTYTWOINDICES,CRITICALTOTHESURVIVALTIMEOFTHEPATIENTS,WASSELECTEDFROMTHEORIGINAL241INDICES,WHICHAREFROMTHESURVIVALANALYSISOFKAPLANMEIERMETHODS,ANDSTATISTICALANALYSISTHELOGRANKTESTANDBRESLOWTESTTOTHESURVIVALRATEOFPATIENTSINTHENEARANDFARFUTURECLASSIFICATIONMETHODSWEREAPPLIEDTOTHE52INDICESTOREDUCETHEEFFECTSOFTHEPOSSIBLEMULTIVARIABLECODEPENDENCETHERESULTING33INDICESFROMTHECLASSIFICATIONMETHODCOULDBEUSEDTOCONSTRUCTTHEREGRESSIONMODELTABLE2SURVIVALINFORMATIONOFPATIENTSGROUPNPERCENTSURVIVALTIME30DAYSOFSURVIVALTIME60DAYSOFSURVIVALTIME90DAYSOFSURVIVALTIME180DAYSOFSURVIVALTIMEONEYEAROFSURVIVALTIMEDEATH358679511185128110188160211170357170287180SURVIVAL1693216827611030060090018003600TOTAL5271000253734219303553404723407963401413340NOTEEVERYVALUEBETWEENPARENTHESESISMEDIANINTHETABLECCONSTRUCTIONOFTHEREGRESSIONEQUATIONCOXPROPORTIONALHAZARDREGRESSIONWASAPPLIEDTOTHE33INDICESFROMTHEABOVEANALYSISTHEPVALUEWASSETTOBELESSTHAN005FORTHEVARIABLESACCEPTEDORREMOVEDFROMTHEMODELX2TESTWASAPPLIEDTOTHEREGRESSIONEQUATIONFITTINGPROCESS,INWHICHTHEX2VALUEIS1453P0001NINEINDICESWEREFINALLYRETAINEDINTHEREGRESSIONEQUATIONWHICHWEREALIMENTARYTRACTHEMORRHAGEH43,AGE,DEGREEOFASCITESC5,ALTINITSNATURALLOGARITHM,AST/ALTINNATURALLOGARITHM,TBILINNATURALLOGARITHM;(MG/DL),CHINNATURALLOGARITHM,CRMG/DLINNATURALLOGARITHM,ANDPTAINNATURALLOGARITHMTABLE3SHOWSALLTHEINDICESRETAINEDINTHEREGRESSIONEQUATIONTHEBASELINECUMHAZARDOFREGRESSIONMODELISLISTEDINTABLE4INTHISSTUDY,THEPROGNOSTICINDEXFORMULATIONFORTHESEVEREHEPATITISSUFFERERSISPI0493H430028AGE0189C50233LNALT0379LNAST/ALT0424LNTBIL0369LNCH017LNCR0899LNPTATHECUMULATIVESURVIVALFUNCTIONOFTHEEACHSUFFERERINSTAGESCANBECALCULATEWITHTHISFORMULA0,THPIETSETHTH−WHEREPIISPROGNOSTICINDEX,H0TISBASELINECUMHAZARD,HTISCUMHAZARD,STISCUMSURVIVALTABLE3VARIABLEINFORMATIONINCOXFUNCTIONVARIABLEBSEWALDPORH43493149109900011637AGE028005348320001029C518906292420021208LNALT233070110030011262LNASTALT37912690400031461LNTBIL42413894700021528LNCH36911310715001691LNCR17008539880461186LNPTA89914041102000407TABLE4BASELINECUMHAZARDOFMODELTIME30D60D90D180D360DH0TBASELINECUMHAZARD00170025002700290030DCOMPARISONBETWEENRESULTSFROMTHEPROGNOSTICMODELINTHISSTUDYANDTHOSEFROMCTPANDMELDINORDERTOVERIFYTHERESULTSOFTHISSTUDY,THEINFORMATIONOF400PATIENTSWASCOLLECTEDFOREACHPATIENT,THECUMSURVIVAL,CTPSCORE,ANDMELDSCOREARECALCULATEDTHEROCCURVEANDTHEAREAUNDERTHECURVEAREUSEDTOESTIMATETHEVERACITYOFTHEPATIENT’SSURVIVALINDIFFERENTSTAGESSUCHAS30DAYS,60DAYS,90DAYS,180DAYSANDONEYEARASTHESTATISTICALRESULTSFROMTABLE5AND6,THEREGRESSIONMODELINTHISSTUDYHASBETTERPREDICTIONATTHEDIFFERENTSTAGESTHANTHECTPANDMELDMODELTHEREFORE,THEMODELINTHISSTUDYISMOREAPPLICABLETOLIVERDISEASESUFFERERSINOURCOUNTRYTABLE5AUCOFTHREEMODELSMODELTIME30D60D90D180D360DCTP619625620628622MELD684646633620622THISSYSTEMMODEL782801792789785TABLE6AUC′SCOMPARISONOFTHREEMODELSTIMECOMPAREWITHCTPCOMPAREWITHMELDZPZP30D40900125100560D44000139500190D424001399001180D390001410001360D395001395001ⅣDISCUSSIONSINTHISSTUDY,APROGNOSTICFORMULA,SUITABLETOTHESITUATIONOFCHINAANDTOESTIMATETHEPROGNOSISOFSEVEREHEPATITISANDLIVERFUNCTIONFAILURE,WASDERIVEDBASEDONCOXPROPORTIONALHAZARDREGRESSIONMODELANALYSISOFTHEDATAFROMTHEINPATIENTSANDTHEIRFOLLOWUPSURVEYTHESEDATAWERECOLLECTEDFROMALARGEPOOLOFSAMPLESFROMDIFFERENTHOSPITALSAROUNDTHECOUNTYTHERISKPROGNOSTICFORMULADERIVEDFROMTHISSTUDYINCLUDE9INDICESWHICHAREREGULARLYUSEDINCLINICALALIMENTARYTRACTHEMORRHAGE,AGE,DEGREEOFASCITES,ALTINNATURALLOGARITHM,AST/ALTINNATURALLOGARITHM,TBIL(MG/DL)INNATURALLOGARITHM;CHINNATURALLOGARITHM,CRMG/DLINNATURALLOGARITHM,ANDPTAINNATURALLOGARITHMTHETBILANDDEGREEOFASCITESARESAMEASTHOSEINCTPSCORINGANDCLASSIFICATIONTHEREARECORRELATIONSBETWEENTHEPTAANDTHEPTINTHECTPSCORINGSYSTEMCRANDTBILARESAMEASTHOSEINTHEMELDMODELWHICHAREBEINGWIDELYUSEDINABROADALIMENTARYTRACTHEMORRHAGEANDASCITESARECOMPLICATIONSUSUALLYSEENINTHESEVEREHEPATITISPATIENTANDONEOFTHEMAJORREASONSLEADINGTOTHEDEATHOFPATIENTSANYEXPERTOFLIVERDISEASEAGREESTHATTHESETWOCOMPLICATIONSARETHEFIRSTHANDTHREATTOPATIENT’SLIFE,SINCETHESEPATIENTSHAVEBADPROGNOSISPREVIOUSFINDINGSINDICATETHATPROGNOSISBECOMEWORSEWITHAGEITWASREPORTEDTHATPROGNOSISISBADWHENAGEISOVER50ANDTHATTHEDEATHRATE
编号:201311191259533768    类型:共享资源    大小:228.86KB    格式:PDF    上传时间:2013-11-19
  
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