慢性肝衰竭患者终末期肝病模型预后判断的分析

Analysis of prognosis patients with chronic liver failure using the criterion of the model end-stage liver disease

目的探讨终末期肝病模型(MELD)在慢性肝衰竭患者预后判断的意义。方法对152例慢性肝衰竭患者的临床资料进行回顾性分析,计算入院时MELD分值及药物治疗2周后MELD分值与入院时MELD分值的差值ΔMELD,同时了解患者3个月病死率。结果9例患者在3个月内死亡,MELD分值在MELD≤9、9<MELD≤19、19<MELD≤29、MELD≥30各组中,患者三个月病死率分别为8.3%、16.7%、23.6%、73.5%。各组与MELD≥30组相比较,差异显著有统计学意义,(χ2=71.54、20.69、24.51,P值<0.01)。MELD≥18与MELD<18两组患者3个月病死率分别为37.7%与15.8%,两组差异有统计学意义(χ2=6.27,P值<0.05)。ΔMELD>0组3个月病死率(52.5%)明显高于ΔMELD≤0组(18.7%),具有统计学意义(χ2=19.07,P值<0.01)。结论MELD能较为准确地预测慢性肝衰竭患者的短期预后,ΔMELD也可准确地预测慢性肝衰竭患者的短期预后。

Objective To investigate the prognosis evalution of patients with chronic liver failure （CLF） using the criterion of the model of end-stage liver disease（MELD） .Methods The MELD scores of 152 CLF patients on the day of their admittance to hospital and the △MELD scores after two-weeks of medical treatment were retrospectively analyzed,and compared with the scores of the threemonth mortality rate of the patients. Results 49 patients died within three months. The three-month mortality rate of those with MELD≤9,9 〈 MELD≤19,19 〈 MELD≤ 29 and MELD≥ 30 was 8.3%, 16.7% ,23.6% and 73.5% respectively, and the three-month mortality rate whose with MELD≥30 was compared with the others respectively. The differences were all highly significants（ X^2 was 71.54,20.69 and 24.51 respectively, P 〈0.01 ）.The three-month mortality rate of those MELD≥ 18 and MELD 〈 18 was 37.7% and 15.8 %, the difference was highly significant（ X^2 = 6.27 P 〈 0.05）. When △MELD scores was above zero, the three-month mortality rate was 52.5%,and when △MELD scores was less than or equal to zero,the three-month mortality rate was 18.7%,the difference between them was highly significant X^2 = 19.07 P 〈 0.01）. Conclusion MELD scores can accurately predict the shortterm prognosis of patients with CLF,and △MELD can also accurately predict the short-term prognosis of patients with CLF.