重型肝炎患者人工肝治疗前后的终末期肝病模型分析

Analysis of prognosis for severe hepatitis with artificial liver support system using the criterion of model for end-stage liver disease

目的通过观察终末期肝病模型(MELD)在重型肝炎患者人工肝治疗后3个月时的预后分析,探讨其在临床应用的价值及对人工肝支持系统的治疗效果。方法99例重型肝炎患者分成对照组和人工肝组,观察两组在治疗前与治疗后2周MELD的评分变化及3个月时的死亡率。结果治疗后2周,两组患者MELD评分较治疗前均有所下降,但20≤MELD≤29和30≤MELD≤39者MELD评分下降与治疗前比较有显著性差异(P<0.05),且人工肝组与对照组比较MELD评分下降也有显著性差异(P<0.05)。MELD≤19和MELD≥40者治疗前后组内及组间比较无显著性差异。人工肝治疗后分值20≤MELD≤29和30≤MELD≤39者3个月时的死亡率与对照组比较差异有显著性(P<0.05)。而MELD≤19和MELD≥40者人工肝治疗后的死亡率与对照组比较差异无显著性(P>0.05)。结论20≤MELD≤29和30≤MELD≤39者患者应积极进行人工肝治疗。MELD≤19分者临床可以积极内科保守治疗而不必进行人工肝治疗。MELD>40者应尽早行肝移植手术以挽救患者生命。

Objective To study the usefulness of model for end-stage liver disease（MELD） in clinical practice and the role of artificial liver support system（ALSS） in end-stage liver disease. Methods Ninety nine patients with sever hepatitis were divided into artificial liver support treatment and control groups. Changes of MELD score before and 2 weeks after plasma exchange（PE）treatment and the rate of death after 3 months were followed. Results The MELD scores were decreased after treatment in two groups, and in case of 20 ≤ MELD ≤ 29 and 30≤ MELD ≤ 39 the decrease was significant than pre-treatment（ P 〈 0.05）, and it was more marked in patients with artificial liver support than control groups. It was not marked in MELD≤ 19 and MELD≥40 patients, and the death rates after 3 month treatment in patients of 20 ≤ MELD ≤ 29 and 30 ≤ MELD ≤ 39 were significantly lower than that of control group. In MELD ≤ 19 group and MELD≥ 40 it was not siginificat （ P 〉 0.05）. Conclusion MELD can be used in clinical practice and PE can decrease the rate of death 3 months after in end-stage liver disease of 20 ≤ MELD ≤ 29 ≤ 30 ≤ MELD ≤ 39 patients, the patients of MELD ≤ 19 could be treated with conservative therapy, but patients of MELD ≥ 40 have the indication for liver transplantion.