MELD-Na模型评分对评估失代偿期肝硬化患者短期预后的临床价值

The short-term prognostic value of the model for end stage liver disease including serum sodium in patients with decompensated liver cirrhosis

目的评价终末期肝病模型(MELD)评分、Child-Pugh(CTP)计分及MELD-Na模型评分(MELD-Na+)对失代偿期肝硬化患者短期预后的预测价值。方法分别计算116例失代偿期肝硬化患者的MELD、Child-Pugh及MELD-Na分值,运用ROC曲线及曲线下面积(AUC)比较三种评分系统判断失代偿期肝硬化患者短期预后的准确性。结果116例患者随访3个月内有34例患者死亡,死亡组MELD-Na评分(24.1±2.5)与生存组(15.4±2.9)比较差异有统计学意义(P<0.001);在判断患者预后的ROC曲线AUC比较中,MELD-Na评分(0.825)>MELD评分(0.779)>Child-Pugh分级(0.626,P<0.05)。结论Child-Pugh计分、MELD计分和MELD-Na计分均可有效地预测失代偿期肝硬化患者的短期预后,而MELD-Na模型评分对短期评估效率优于其他两种方法,能更准确地反映病情的轻重,更具有临床应用价值。

Objective To evaluate the clinical value of the MELD model,Child-Pugh （CTP） and the MELD-Na model in the short-term prognostic prediction with decompensated liver cirrhosis patients. Methods The patients were graded with MELD,Child-Pugh and MELD-Na scores;The accuracy of the three parameters on predicting survival were analyzed and compared with each other using the area under the receiver operating characteristic （ROC） curve （AUC）. Results Thirty four patients died within 3 months,whose MELD-Na score （24.1±2.5） were higher than those of survivors （15.4±2.9,P〈0.001）. The AUC values generated by the ROC curves for the MELD-Na were 0.825,higher than the MELD and the Child-Pugh （P〈0.05）. Conclusion The results suggestes that the involvement of serum sodium can improve the values of MELD model. Child-Pugh score,MELD score and MELD-Na score can accurately predict the short-term prognosis of patients with decompensated liver cirrhosis,while MELD-Na score is superior to the others.