MELD评分联合血清胆红素水平预测肝硬化预后

Evaluateing prognosis of cirrhotic patients by MELD score combined with serum bilirubin

目的比较childpugh评分、MELD评分体系及MELD联合血清胆红素对肝硬化失代偿期患者的短期、中期死亡危险的预测价值。方法入选59例肝硬化失代偿期患者,分别根据随访6月及12月的存活情况分组,观察存活组与死亡组中血清胆红素水平、血清肌酐水平、INR值、childpugh评分、MELD评分。结果随访至6月,8例死亡,存活组与死亡组血清总胆红素水平、INR值、childpugh评分、MELD评分均有统计学差异。随访至12月,18例死亡,存活组与死亡组上述各项观察指标均有统计学差异。而年龄、血清肌酐水平均无统计学差异。存活组与死亡组中不同childpugh分级所占比例有统计学差异。MELD评分与childpuSh评分密切相关,r=0.936,P<0.001。在预测死亡的危险性方面,MELD评分联合血清胆红素水平预测6月死亡的敏感性为100%,特异性86.8%。结论MELD评分系统对判断肝硬化肝功能失代偿期患者的预后具有良好的价值和准确性。MELD评分联合血清胆红素与单独MELD评分、ChildPugh评分系统相比,在预测肝硬化肝功能失代偿期患者短、中期死亡率方面也具有更好的作用。

Objective To evaluate the short and medium term mortality prognosis of a series of cirrhotic patients by means of Child - Pugh score, MELD score and MELD score combined with serum bilirubin. Methods We retrospectively evaluated survival of a cohort of 59 cirrhotic patients with a follow up period of at least one year. The Child-Pugh score was calculated and the MELD score was computed according to the original formula for each patient. Multivariate analysis was performed on all variables to identify the parameters independently associated with six months and one year mortality. Results Eight patients died within six months and eighteen patients died within the first year of follow up. The serum bilimbin, intemational normalized ratio （INR）, Child-Pugh scores, and MELD scores were significantly different among patients who survived and those who died. The age and serum creatinine were no difference. MELD score combined with serum bilimbin showed sensitivity （100%） and specificity（86.8% ） in predicting six months mortality. MELD score showed significant correlations with Child-Pugh score, r = 0.936, P 〈 0.001. Conclusion The M ELD score is an excellent predictor of both short and medium term mortality prognosis of a series of cirrhotic patients. Addition of serum bilimbin into the MELD score predicts mortality better than MELD alone or child - pugh score.