Objective To evaluate the prognosis of patients combined with acute（subacute）hepatic failure and hepatic encephalopathy after artificial liver treatment. Methods The clinical data of 25 patients who received artificial liver treatment were collected. Parameters including total bilirubin，albumin，prothrombin activity and blood ammonia before and after treatment were collected. Total bilirubin clearance rate（TBCR），total bilirubin actual resident ratio（TBARR），total bilirubin rebound rate（TBRR）and ΔMELD score were compared. Results The Prothrombin activity and ammonia clearance were higher in the improvement group，the TBARR，TBRR and ΔMELD score were lower in the improvement group compared with deterioration group，the differences were statistically significant（P ＜ 0.05）. There was no difference between the two groups in albumin ，blood ammonia and MELD score. The AUC of TBARR、 TBRR and ΔMELD was 0.794、0.816、0.897. Conclusion TBARR，TBRR and ΔMELD could predict the prognosis of patients with artificial liver treatment ，of which Δ MELD could predict the prognosis more precisely.

目的 评估人工肝治疗急（亚急）性肝衰竭合并肝性脑病患者的预后。方法 收集 25 例进行人工肝治疗患者的临床资料，收集患者治疗前后总胆红素、白蛋白、凝血酶原活动度、血氨等指标，并计算总胆红素清除率（total bilirubin clearance rate，TBCR）、总胆红素存留率（total bilirubin actual residentratio，TBARR）、 总 胆 红 素 反 弹 率（total bilirubin rebound rate，TBRR） 及 ΔMELD 评 分 等 相 关 指 标。结果 好转组凝血酶原活动度、血氨清除率高于恶化组，而 TBARR、TBRR 及 ΔMELD 评分低于恶化组，差异有统计学意义（P ＜ 0.05），两组间的白蛋白、血氨、MELD 评分差异未见统计学意义（P ＞ 0.05）。通过绘制 ROC 曲线，TBARR、TBRR 及 ΔMELD 评分曲线下面积分别为 0.794、0.816、0.897。结论 TBARR、TBRR 及 ΔMELD 评分对行人工肝治疗患者的预后有一定预测价值，其中以 ΔMELD 评分的预测价值最大。

人工肝 , 肝衰竭 , 肝性脑病 , 总胆红素存留率 , 总胆红素反弹率 , ΔMELD 评分