失代偿期肝硬化患者的MELD评分与预后

MELD scoring system and prognosis in patients with decompensated liver cirrhosis

目的评价MELD评分系统在晚期肝病中的应用。方法对87例住院失代偿期乙肝肝硬化患者进行MELD评分,同时进行C-T-P评分。随访3、12、24月的生存率,并分组比较。结果随访3月病死率31.0%;12月病死率40.2%;24月病死率为75.9%。以MELD系统R为18分组比较,显示>18分组3月、12月的病死率明显高于≤18分组(P=0.001及0.006),24月无明显差异;以R≤9分、10～19分、20～29分、30～39分、≥40分组比较,显示≤9分组3月、12月病死率为0,≥40分组3月病死率为100%,10分以上者在24月均有较高的病死率。C-T-P评分有相类似的结果。结论MELD对失代偿肝病1年内的短期预后判定较为准确。C-T-P系统也是良好的肝功能评价方法之一。

Objective To investigate the application of MELD scoring system in patients of end-stage liver disease. Methods Eighty-seven patients with decompensated liver cirrhosis due to hepatitis B were analyzed with MELD scoring system and Child-Tureotte-Pugh scoring system. The follow-up time were 3, 12 and 24 months. The survival rates were compared in different groups which were divided according to the follow-up time. Results The mortality in 3, 12 and 24 months were 31.0 % （27/87） , 40.2 % （35/87） and 75.9 % （66/87） , respectively. According to the MELD scoring system, R = 18 was determined as the dividing point. In the groups of 3 months and 12 months, the mortality of R 〉 18 was higher than that of R≤ 18 （P=0. 001 及 0. 006）, but the mortality was no difference in the group of 24 months. The mortality of R≤9 in the groups of 3 months and 12 months were 0. And the mortality of R≥40 in the group of 24 months was 100%. In the group of 24 months the cases with Pugh scoring system provided a similar outcome. Conclusion R 〉 10 maintained a higher mortality. The Child-Turcotte-Pugh scoring system provided a similar outcome. Conclusion The MELD scoring system can provide a relatively exact prognosis for the patients with decompensated liver cirrhosis less than 1 year. The Child-Turcotte-Pugh scoring system is also a good evaluating method.