终末期肝病模型联合血清钠对失代偿期肝硬化患者预后评估的价值

Prognostic value of the model for end-stage liver disease combined with serum sodium levels in patients with decompensated cirrhosis

目的评价终末期肝病模型（MELD）联合血清钠MELD-Na、MELDNa、MESO模型对评估我国失代偿期肝硬化患者预后的价值。方法对212例失代偿期肝硬化患者进行回顾性分析，随访患者在3、6、12个月的预后，分别应用MELD及MELD-Na、MELDNa、MESO模型进行评分，用受试者特征曲线（ROC）下面积（AUC）比较各评分系统预测患者生存不同时间的准确性。依据ROC曲线的截断值绘制Kaplan-Meier生存曲线。计量资料应用t检验；计数资料用彳。检验；ROC曲线下面积的比较采用正态性Z检验；Kaplan-Meier生存曲线的比较用Logrank检验。结果212例肝硬化患者3、6、12个月内分别死亡46、56、87例。随访3、12个月中，死亡组患者的MELD、MELD-Na、MELDNa及MESO评分均高于生存组患者（P〈0．01）。判断患者3、6个月预后，四种模型的AUC均在0．8以上，其中MELDNa（0．846，0．869）及MFSO（0．831，0．850）与MELD（0．812，0．841）比较，差异有统计学意义妒〈0．05）。判断患者12个月预后，MELD、MELD—Na、MELDNa、MESO的AUC值分别为0．774、0．775、0．786、0．777，各模型之间AUC差异无统计学意义。生存分析显示四种评分系统均可有效预测12个月内可能生存或死亡的患者妒〈0．01）。结论MELD及其联合血清钠模型均可有效地预测失代偿期肝硬化患者中短期预后，MELDNa和MESO对患者短期预后评估的准确性优于MELD。

Objective To investigate the ability of the model for end-stage liver disease （MELD） score combined with serum sodium measurements to effectively evaluate the prognosis of patients with decompensated liver cirrhosis. Methods A total of 212 patients with decompensated cirrhosis were retrospectively analyzed. Each patient＇s MELD scores, and sodium-based MELD scores （MELD-Na, MELDNa, and MESO） were calculated at three-month intervals. The area under the receiver operating characteristic （ROC） curve （AUC） was used to compare the predictive abilities of the four scores for 3-, 6- and 12-month mortality. Kaplan-Meier survival curves were created using the best cut-off values for each score identified by the ROC. Results Among the 212 patients, 46 died within three months, 56 died within six months, and 87 died within 12 months. The MELD, MELD-Na, MELDNa and MESO scores were significantly different between patients who survived and those who died within three and 12 months （P〈0.01）. The AUCs for the four separate scores were all 〉0.8 at the 3- and 6-month time points; however, the AUCs of MELDNa （3-month： 0.846; 6-month： 0.869） and MESO （0.831; 0.850） were significantly better than those ofMELD （0.812; 0.841） （P〈0.05）. At the 12-month time point, the AUCs ofMELD, MELD-Na, MELDNa, and MESO were not significantly different （0.774, 0.775, 0.786, and 0.777, respectively）. Survival curves showed that all the scores were able to clearly discriminate the patients who survived from those who died within 12 months （P=0.000）. Conclusion The MELD score and its sodium-based variants （MELD-Na, MELDNa, and MESO） can precisely predict mortality of patients with decompensated cirrhosis for short and intermediate periods. The MELDNa and MESO scores are superior for predicting 3- and 6-month survival.