The Value Of Serum Total Bile Acid Combined With MELD Score In Predicting The Prognosis Of Patients With Decompensated Hepatitis B Liver Cirrhosis

Objective:To investigate the evaluation of serum total bile acid on liver damage and liver anabolic function;To explore the relationship between Model for end-stage of liver disease and serum total bile acid;To assess the predictive value of serum total bile acid combined with MELD score for the short-term prognosis in the decompensated hepatitis B liver cirrhosis patients.Methods:Collected complete medical records of 84 patients of decompensated hepatitis B cirrhosis in Subei People’s Hospital liver and spleen medicine from August 2016 to August 2017 and established the clinical data table.The follow-up time was 6 months.According to 6 months survival,they were divided into death group and survival group.Understand the general clinical data of both groups and compare the differences of serum total bile acids,MELD score,total bilirubin,international normalized ratio and serum creatinine between the two groups.Analyze the correlation between TBA level and MELD score in 84 cases of decompensated hepatitis B liver cirrhosis.Receiver operating characteristic curve(ROC curve)was used to evaluate the predictive ability of serum TBA and MELD score on the 6 month prognosis of patients with decompensated hepatitis B liver cirrhosis.Kaplan-Meier survival curves were made using the cut-offs of ROC curve,and to analyze the prognostic value of TBA combined with MELD score in patients.Results:1.The mean level of TBA of death group in patients with decompensated hepatitis B liver cirrhosis was(55.36±65.35),which was significantly higher than that of the survival group(28.85 + 38.83)(P<0.05).2.With the increase of MELD score and the increase of total bile acid level,The r=0.704,P=0.00,MELD scores were significantly positively correlated with serum TBA with pearson analysis.3.The area under ROC curve of MELD score and serum TBA were 0.817 and 0.766 for the 6 months prognosis of patients with decompensated hepatitis B cirrhosis,and the the cutoff values of MELD and TBA were 50 and 35.3μmol/L respectively.The two judgments have good sensitivity and specificity in predicting the death of patients in 6 months.4.With MELD = 50 and TBA=35.3 for limit,the Kaplan-Meier survival curves showed that patients with decompensated hepatitis B cirrhosis deaths at greatest risk of fourth groups that MELD score>50 and TBA>35.3.The risk of death was the lowest in the first group of MELD<50 and TB A3 5.3.The risk of death of the second group of MELD score<50 and TBA>35.3 is similar to the third group of MELD score>50 and TBA<35.3,It shows that the prognosis of patients with high TBA level and low MELD level is similar to the prognosis of patients with low TBA level and high MELD level.Meanwhile,it is also indicated that the total bile acid combined with MELD score is an effective supplement to the MELD score,and it is more accurate to judge the short-term prognosis of the patients.This study suggests that serum total bile acid combined with MELD score can improve the accuracy of short-term prognosis in decompensated hepatitis B cirrhosis patients.Conclusions:1.The mean level of TBA of death group was significantly higher than that of the survival group,and the prognosis of patients with high serum total bile acid was poor.2.The total bile acid combined with MELD score is an effective supplement to the MELD score,and it can improve the accuracy of the evaluation of the short-term prognosis of patients with liver cirrhosis in the decompensation period.3.The MELD score and serumTBA can be used to judge the severity and short-term prognosis in patients with decompensated hepatitis B liver cirrhosis.Therefore,the combination of MELD score and serum TBA is a good indicator for predicting the short-term prognosis of liver cirrhosis.