239例肝硬化失代偿期患者的短期预后评估

The short-term prognosis evaluation of 239 Chinese patients with decompensated liver cirrhosis

目的评价终末期肝病模型(MELD)、MELD-Na、Child-Turcotte-Pugh(CTP)和包含血肌酐值的CTP(CrCTP)评分对肝硬化患者短期预后的评估意义。方法回顾性收集自2005年1月—2007年12月我院收治的239例肝硬化失代偿期患者的病例资料,分别应用CTP、CrCTP、MELD和MELD-Na模型进行评分,并了解其3个月内的病死率。以受试者工作特征曲线(ROC)下面积(AUC)衡量各评分系统预测肝硬化失代偿期患者短期预后的能力,并运用Z检验比较各系统的预测能力。结果30例患者在3个月内死亡。死亡组患者的CTP、CrCTP、MELD和MELD-Na分值(分别为11.47±2.46、12.47±2.05、19.70±6.71、27.97±10.79)与生存组(分别为8.73±2.03、8.95±2.13、10.92±4.74、14.48±6.55)相比差异有统计学意义(P<0.001)。CTP、CrCTP、MELD和MELD-Na评分对肝硬化失代偿期患者3个月预后评估的ROC曲线下面积分别为0.799、0.822、0.873、0.870。结论CTP、CrCTP、MELD和MELD-Na模型均可有效预测我国肝硬化失代偿期患者的短期预后;MELD评分在判断肝硬化失代偿期患者的短期预后方面优于CTP;在CTP中引入血肌酐值即CrCTP评分可以提高对肝硬化失代偿患者短期预后的判断准确性;MELD-Na模型未显示比MELD更佳的预测能力。

Objective To evaluate the short-term prognostic meaning of the model for end-stage liver disease （MELD） score, MELD Na system, Child Turcotte-Pugh （CTP） and the creatinine modified CTP （CrCTP） grading in Chinese patients with decompensated liver cirrhosis. Methods A cohort of 239 hospitalized patients with decompensated liver cirrhosis in Shanghai Renji hospital were retrospectively studied with follow up period of 3 months. The MELD, MELD-Na, CTP and CrCTP scores were calculated according to the clinical data for each patient to compare their values in prognosis. Receiver operating characteristic eurve（ROC） and the area under the eurve（AUC） were used to measure the values of the four models to predict the 3-month survival, and Z-test was used to compare their predictive values. Results 30 patients died within 3 months. CTP, CrCTP, MELD and MELD-Na scores for non-survivors（l1.47 ± 2. 46, 12.47 ± 2.05,1 9. 70 ± 6. 71 , 27. 97 ± 10. 79） were higher than those for survivors（8. 73 ± 2. 03,8. 95 ± 2. 13,10. 92 ± 4.74, 14.48± 6.55）significantly （P〈0. 001 ）. The AUC values generated by the ROC curves for CTP. CrCTP and MELD were 0. 799, 0. 822, 0. 873 and 0. 870 respectively in predicting 3-month survival. Conclusion CTP, CrCTP, MELD and MELD-Na score can accurately predict the 3-month survival of patients with decompensated liver cirrhosis in our hospital. The MELD score is superior to CTP score in short-term prediction. The involvement of serum creatinine might improve the values of CTP score in predicting 3 month survival. The MELD-Na score is not superior to the MELD score.