慢性重型肝炎肝移植的手术时机

Timing for liver transplantation for chronic severe hepatitis

目的探讨慢性重型肝炎肝移植的手术时机。方法回顾性分析135例慢性重型肝炎病人的临床资料，应用终末期肝病模型（MELD）评估病人病情，比较病人入院时MELD值和接受治疗2周后△MELD值与病人3个月死亡率之间的关系。结果死亡组病人入院时MELD值为37±7，存活组为26±5，两组间差异有显著统计学意义（P〈0．01）；死亡组病人接受治疗2周后△MELD值为1．6±2．2，存活组为-1±5，两组间差异有显著统计学意义（P〈0．01）。病人入院时MELD值和接受治疗2周后MELD值预测慢性重型肝炎病人3个月内死亡率的c—statistic分别为0．903和0．760。如MELD值〈25，病人3个月后死亡率为1．8％；25≤MELD值≤30，死亡率为7．4％；30〈MELD值〈35，死亡率为42．9％；MELD值≥35，死亡率为80．6％，各组间死亡率比较差异有非常显著的统计学意义（P〈0．01）；△MELD分值〉0组和≤0组的死亡率分别为51％和13．1％，两组间死亡率有非常显著的差异（P〈0．01）。结论MELD分值和△MELD分值与慢性重型肝炎病人的死亡率呈正相关，MELD能较准确地预测慢性重型肝炎病人的病情转归，临床医生可以结合病人入院时的MELD分值和接受治疗后的△MELD分值来决定慢性重型肝炎病人中转肝移植的手术时机，MELD值≥35时应该行肝移植治疗。

Objective To determine the optimal time for liver transplantation for chronic severe hepatitis （CSH）. Methods The clinical data of 135 patients with CSH treated in our hospital were retrospectively analyzed. The MELD score of the patients on the first day after being admitted to hos pital and that after internal treatment for 2 weeks were calculated and compared. Meanwhile, the relaion of the scores to 3-month mortality of the patients was determined. Results MELD score on the first day after being admitted to hospital was 37±7 in dead group and 26±5 in live group （P〈0.01）. The AMELD score after internal treatment for 2 weeks was 1.6±2.2 in dead group and -1±5 in live group （P〈0.01）. The area under the ROC curve of MELD score （C-statitic） was 0. 903 while the C-statistlc for AMELD score was 0. 760. The 3-month mortality was 1.8%, 7.4%, 42.9% and 80.6%, respectively, if the MELD score 〈25, 25≤MELD score≤30, 30〈MELD〈35 and≥35. There was marked difference （P〈0.01）. If the △MELD score was over zero, the 3-month mortality was 51%. If the △MELD score was less than or equal to zero, the 3-month mortality was 13.1%. There was remarkable difference （P〈0.01）. Conclusion MELD score and △MELD score are positively correlated with the 3-month mortality in patients with CSH and MELD is quite excellent in assessing prognosis of the patients. By integrating the MELD score and △MELD score, doctors can find the optimal time of liver transplantation for CSH. MELD score ≥35 means that liver transplantation is necessary.