MELD评分预测终末期肝病肝移植术后短期生存率的研究

The study about pretransplantation MELD score in predicting short-term survival of patients with end-stage liver disease post liver transplantation

目的:探讨MELD评分对终末期肝病肝移植术后短期生存率的预测效果。方法:回顾性分析我院自2000年1月￣2005年11月33例行肝移植手术的终末期肝病受者术前MELD评分及术后3个月、6个月的生存率,依据MELD评分结果将受者分为3组(≤20,21￣30之间,≥30),分析比较各组生存率之间有无统计学差异。同时比较他们术中的尿量。结果:术后3个月总的生存率为90.1%(30/33),6个月的生存率为81.8%(27/33),MELD分值≤20的受者与分值在20￣30之间患者的3个月生存率分别为100.0%和92.3%(P=0.861),两组比较差异无显著性。MELD分值≥30的受者术后3个月生存率与前两组比较差异均有显著性(P值分别为0.012和0.041)。术后存活时间大于3个月的受者术中尿量为126.2±118.9m1/h,术后3个月内死亡的受者为25.3±22.6ml/h,两者差异有显著性(P=0.0001)。结论:1.终末期肝病肝移植术前MELD评分不能完全预测术后的生存率,因为两者不存在线性关系,只有在达到一临界点的时候,生存率才出现明显下降;2.术中尿量可以综合评价术前、术中各种因素对肾功能的损害程度以及术后肾功能状况,而且与术后生存率密切相关。

The aim of this study is to explore pretransplantation MELD score in predicting shortterm survival of patients with endstage liver disease post liver transplantation.Methods：We studied 3 months and 6 months patient survival in 33adult patients who underwent liver transplantation between January 2000 and November 2005 in our hospital.The MELD score pretransplantation was recorded.We shared categories of their MELD score（≤20,21～30,≥30）and compared their survival.In our study,we also compared urine volume （ml/h）of the patients during operation.Results：The total survival rates in 3 month and 6 months after transplantation were respectively 90.1%（30/33）、81.8%（27/33）,there were respec-tively 100.0%、92.3%（P=0.861）in those patients with a MELD score of lower 20 and 21～30 in 3 monbhs swwival rate,they had no significance.We found only those patients with a MELD score of 30 or higher had a survival that was markedly lower than the rest（P=0.012 and 0.041）in 3 months survival rocte.The urine volume （ml/h）of survival patients whese survival time exceeded 3 months during operation （126.2±118.9ml/h）was obviously higher than the dead ones within 3 months（25.3±22.6ml/h）,they were significant（P=0.0001）. Conclusions：1 The ability of the pretransplantation MELD score to predict short-term survival of patients with end-stage liver disease post liver transplantation is uncomplerely,because they do not have linear relation and there is a threshold in the MELD score beyond which survival decreases in such a fashion.2 The urine volume （ml/h）dnring operation can predict the lesion of Kidney from the factors before and during operation.It also correlates to the risk of patients post-transplantation.