终末期肝病模型评分与Child-Pugh评分对失代偿期肝硬化患者的预后分析

Analysis on prognosis of decompensated liver cirrhotic patients using Model for End-stage Liver Disease score and Child-Pugh score

目的比较终末期肝病模型(MELD)评分Child-Pugh评分、对失代偿期肝硬化患者的短期死亡危险的预测价值。方法回顾性分析2000年1月2005年10月收住我院的失代偿期肝硬化死亡患者14例及好转37例,观察存活组与死亡组中患者血清总胆红素水平、凝血酶原时间国际标准化比值(INR),血清肌酐水平、血清凝血酶原时间、血清白蛋白、MELD评分及Child-Pugh评分,并对相关数据进行统计分析。结果存活组与死亡组中血清胆红素水平、血清肌酐水平、MELD评分、Child-Pugh评分差异有统计学意义,而年龄、性别差异均无统计学意义。COX回归分析显示MELD评分、Child-Pugh评分与失代偿期肝硬化患者的预后有显著相关性(P=0.013,0.03),当MELD评分≥15分判断失代偿期肝硬化患者短期死亡的敏感度为71.3%,特异度为85.4%。MELD评分与Child-Pugh评分密切相关(r=0.726,P<0.001),C统计学显示:MELD评分,Child-Pugh评分的ROC曲线下面积分别为0.930,0.824(P<0.005)。结论MELD评分系统与Child-Pugh评分对判断失代偿期肝硬化患者的预后具有良好的预测价值和准确性,均是预测失代偿期肝硬化患者死亡的独立危险因素,MELD评分较Child-Pugh评分具有更高的精确性和准确性。

Obieetive To compare Child-Pugh classification,Model for End-stage Liver Disease（MELD） score for patients with decompensated cirrhosis in the short-term risk of death-predictive value. Methods To retrospectively evaluate deaths of 14 cirrhotic patients and survivors of 37 cirrhotic patients, serum bilirubin, intenational normalized ration（INR）,serum creatinine PT,ALB, MELD score and Child-Pugh score were recorded and compared statistically. Results Serum bilirubin,INR,serum ereatinine,MELD score and Child-Pugh score were significantly different among the patients who survived and those who died. The age and sex were no significant difference. COX regression showed MELD score and Child-Pugh score were significantly associated with the prognosis for deeompensated cirrhotic patients （ P =0. 013,0.03）. MELD seore≥15 showed sensitivity （71.3%） and specificity （85.4%） in predicting short term mortality. MELD score showed significant correlations with Child-Pugh score（ r=0. 726, P〈0. 001）, the area under ROC curve of MELD score and Child-Pugh score were 0. 930,0. 824（ P〈0. 005）. Conclusion MELD score and Child-Pugh score have excellent predictive value and accuracy in the prognosis for decompensated cirrhotic patients. MELD score and Child-Pugh score are dependent predictive risk factors for death deeompensated cirrhotic patients. MELD score has greater precision and accuracy than Child-Pugh score.