meld与pt对乙型肝炎慢加急性肝衰竭患者短期预后的评价

evaluation on short-term prognosis of hepatitis b patients with acute-on-chronic liver failure using meld and pt

目的 比较终末期肝病模型(model for end-stage liver disease,meld)评分系统与pt对乙型肝炎慢加急性肝衰竭患者短期(3个月)预后的预测价值.方法 139例乙型肝炎慢加急性肝衰竭患者分成生存组和死亡组,分别记录入院第2天的meld评分和pt,应用受试者工作特征曲线(roc)曲线下面积评价meld和pt的预测价值,观察3个月内的病死率.结果 生存组患者meld评分和pt分别为25.09±3.92和(26.46±6.46)s,死亡组患者meld评分和pt分别为36.25±6.42和(40.78±10.80)s,两组比较差异有统计学意义(p<0.01).meld评分和pt显著相关(r=0.824,p<0.01).meld评分和pt的roc曲线下面积分别为0.936和0.890,95%的可信区间分别为0.895～0.977和0.839～0.941,差异无统计学意义.结论 meld评分与pt均能较好的预测乙型肝炎慢加急性肝衰竭患者短期临床预后,两者判断预后的价值无统计学差异.患者病死率随meld分值和pt的增加而升高. abstract： objective to compare the model for end-stage liver disease (meld) and pt in survival prediction of hepatitis b patients with acute-on-chronic liver failure. methods one hundred and thirty-nine hepatitis b patients with acute-on-chronic liver failure were divided into survival and death group, and evaluated by meld and ft. the area under roc curve was used to compare the meld and pt. the mortality was observed within 3 months. results the meld score and pt of survival group was 25.09 ± 3.92 and (26.46 ± 6.46) seconds respectively, and those for the death group were 36.25 ± 6.42 and (40.78 ± 10.80) seconds. the differences were of statistical significance ( p < 0.01 ). meld score showed significant correlations with pt(r =0.824, p <0.01). the area under roc curve was 0.936 (95% ci 0.895 ± 0.977 ) on meld score and 0. 890 (95 % ci 0.839 ± 0.941 ) on pt, and there was no significant difference between them. conclusions both meld score and pt can accurately predict the short-term prognosis of hepatitis b patients with acute-on-chronic liver failure. the validity of prognosis by meld is similar to pt. the mortality increases with the meld score and pt increasing.