探究AIMS65、Child-Pugh、终末期肝病模型（MELD）评分联合凝血功能指标在预测肝硬化并发慢加急性肝衰竭（ACLF）中的应用价值。

本研究为回顾性队列研究，选择2019年8月至2024年7月延安大学附属医院收治的247例肝硬化患者作为研究对象，其中44例因不符合纳入标准予以剔除，最终入组203例。收集所有患者的基本人口学特征、基础病史、合并症、凝血功能等实验室指标，以及AIMS65、Child-Pugh和MELD评分进行分析。通过单因素分析和多因素Logistic回归分析，明确影响肝硬化患者并发ACLF的影响因素。绘制各项评分指标及联合检测在诊断肝硬化并发ACLF的受试者工作特征曲线（ROC）并计算曲线下面积（AUC），评价各项评分指标及联合检测在诊断肝硬化并发ACLF的诊断效能。

203例患者并发ACLF（ACLF组）47例，未合并ACLF（非ACLF组）156例。ACLF组患者的Child-Pugh、AIMS65、MELD评分、丙氨酸转氨酶、门冬氨酸转氨酶、总胆红素以及凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血时间（TT）水平均明显高于非ACLF组（P<0.05），而白蛋白、纤维蛋白原（FIB）水平则显著低于非ACLF组（P<0.05）。多因素Logistic回归分析表明，Child-Pugh、AIMS65、MELD评分、PT、APTT、TT是影响ACLF发生的独立危险因素（P<0.05），而FIB则是保护因素（P<0.05）。在诊断肝硬化并发ACLF上，Child-Pugh、AIMS65、MELD评分以及凝血功能联合诊断的AUC为0.847，均明显高于各项评分指标的单独检测值（P<0.05）。联合预测模型在病毒性肝炎、酒精性肝病及代谢相关脂肪性肝病中均表现出良好的预测效能；DeLong检验提示，三组间AUC差异无统计学意义（病毒性vs.酒精性，P=0.712；病毒性vs.代谢相关，P=0.802；酒精性vs.代谢相关，P=0.915）。

AIMS65、Child-Pugh、MELD评分联合凝血功能指标能够有效预测肝硬化患者并发ACLF的风险，有助于临床及时采取干预措施，改善患者预后。

To research the predictive value of AIMS65 score, Child-Pugh score, model for end-stage liver disease (MELD) score combined with coagulation indices in identifying acute-on-chronic liver failure (ACLF) among patients with cirrhosis.

The study was a retrospective cohort study, 247 patients with liver cirrhosis admitted to Yan'an University Affiliated Hospital from August 2019 to July 2024 were selected as the research objects, among which 44 patients were excluded because they did not meet the inclusion criteria, and finally 203 patients were enrolled. The basic demographic characteristics, medical history, laboratory indicators such as coagulation function and the scores of AIMS 65, Child-Pugh and MELD were collected and analyzed. Through univariate analysis and multivariate Logistic regression analysis, the influencing factors of ACLF in patients with liver cirrhosis were clarified. The receiver operating characteristic (ROC) curve was drawn for each scoring indicator and the combined detection in the diagnosis of liver cirrhosis complicated with ACLF, and the area under the curve (AUC) was calculated. The diagnostic efficacy of each scoring index and joint detection in the diagnosis of liver cirrhosis complicated with ACLF was evaluated.

Among the 203 patients, 47 cases developed ACLF (the ACLF group), while 156 cases did not have ACLF (the non-ACLF group). The levels of Child-Pugh grade, AIMS65 score, MELD score, alanine aminotransferase, aspartate aminotransferase, total bilirubin, prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) in ACLF group were significantly higher than those in non-ACLF group, while the levels of albumin and fibrinogen (FIB) were significantly lower than those in non-ACLF group (P<0.05). Multivariate Logistic regression analysis showed that Child-Pugh grade, AIMS65 score, MELD score, PT, APTT and TT were independent risk factors (P<0.05), while FIB was a protective factor (P<0.05). In the diagnosis of liver cirrhosis complicated with ACLF, the AUC of the combined diagnosis of Child-Pugh score, AIMS65 score, MELD score and coagulation test was 0.847, which was significantly higher than that of the single detection of each scoring index (P<0.05). The combined prediction model showed good prediction efficiency in viral hepatitis, alcoholic liver disease and metabolic-related fatty liver disease. DeLong test showed that there was no significant difference in AUC among the three groups (viral vs. alcoholic: P=0.712; viral vs. metabolic correlation: P=0.802; alcoholic vs. metabolic correlation: P=0.915).

AIMS65 score, Child-Pugh score and MELD score combined with coagulation test indexes can effectively predict the risk of patients with liver cirrhosis complicated with ACLF, which is helpful for the clinical implementation of timely intervention measures and improving the prognosis of patients.