赵雪梅，张宇辉，张荣成，黄燕，胡奕然，刘小宁，翟玫，王运红，安涛，甘天翊，张健



临床研究

肝功能Child-Turcotte-Pugh评分在住院心力衰竭患者风险评估中的应用

赵雪梅，张宇辉，张荣成，黄燕，胡奕然，刘小宁，翟玫，王运红，安涛，甘天翊，张健

目的：心力衰竭（心衰）患者常伴有肝功能损害，Child-Turcotte-Pugh （CTP）评分可用于评估肝脏功能，但其在心衰患者的应用尚不清楚。本研究旨在评估CTP评分在预测住院心衰患者死亡的价值。

方法：连续入选1180例因心衰住院的患者，根据患者入院时肝功能情况进行CTP评分并按照CTP评分由小到大将患者分为3组：CTP A级组（n = 951）、CTP B级组（n = 206）及CTP C级组（n = 23），终点事件为全因死亡。

结果：随访1年后，有180例患者发生死亡，CTPA、B、C级心衰患者住院死亡率及1年死亡率均随着CTP等级的升高而增加（住院死亡率0.8%， 11.7%， 56.5%， P＜ 0.001； 1年死亡率 9.6%， 34.5%， 78.3%， P＜ 0.001）。多因素Cox回归分析显示CTP 等级越高患者住院及1年死亡风险越高。CTP评分对住院死亡及1年全死亡判断的受试者工作特征曲线下面积分别为0.88与0.74。Kaplane Meier生存曲线显示出院时由CTP B或C级改善为CTP A级的患者1年生存率明显高于未改善的患者（P=0.028）。

结论：CTP评分可以独立预测住院心衰患者的死亡风险，其住院期间的变化可用于评估患者住院期间的治疗效果。

心力衰竭；死亡；Child-Turcotte-Pugh评分

Abstract

Objective： Heart failure （HF） patients are usually associated with liver function impairment， Child-Turcotte-Pugh （CTP）scores can evaluate liver function， but its effect in HF patients has been unclear. We want to study the application of CTP scores in predicting the risk of death for in-hospital HF patients.

Methods： A total of 1180 consecutive in-hospital HF patients were enrolled. According to CTP scores evaluated liver function at admission， the patients were divided into 3 groups： CTP grade A group， n=951， CTP grade B group， n=206 and CTP grade C group， n=23. The endpoint of this study was all-cause death.

Results： There were 180 patients died at 1 year follow-up period， the in-hospital and 1 year mortalities were increased with the elevated CTP grades accordingly： for in-hospital mortalities in CTP grade A， B and C groups were （0.8%， 11.7% and 56.5%） respectively， P＜ 0.001； for 1 year mortalities were （9.6%， 34.5% and 78.3%） respectively， P＜ 0.001. Multivariable Cox regression analyses indicated that the higher CTP grades， the higher risk of in-hospital and 1 year mortalities in HF patients. The area under curve for CTP scores in predicting the in-hospital and 1 year mortalities were 0.88 and 0.74 respectively. Kaplan-Meier survival analysis presented that the patients with improved CTP scores from grade B or C to grade A at discharge had the higher 1 year survival rate than those without improvement， P=0.028.

Conclusion： CTP scores may independently predict the risk of death for in-hospital HF patients， the levels of CTP scores might be used for evaluating the efficacy of in-hospital treatment.

（Chinese Circulation Journal， 2016，31：668.）

心力衰竭（心衰）是一种复杂的临床综合征，其住院死亡率可达5.3%［1］。心衰患者在血流动力学严重紊乱时，肝脏和肾脏这两类脏器受损最为明显。尽管在心肾综合征方面的研究已经相当透彻，但心脏、肝脏相互作用的研究却明显匮乏［2］。目前评估肝……