终末期肝病模型和急性生理学与慢性健康状况评分系统Ⅱ对慢加急性肝衰竭的预测价值

Clinical value of MELD and APACHEⅡ score to predict prognosis of acute-on-chronic liver failure

目的研究应用终末期肝病模型(model for end-stage liver disease,MELD)评分和急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分对慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)的预测价值。方法对2003年6月至2006年6月天津医科大学消化科住院诊断ACLF患者104例进行回顾性总结分析。结果死亡组的APACHEⅡ评分和MELD评分均高于生存组(P<0.05)。多因素logistic回归分析显示功能不全器官数、APACHEⅡ评分、严重脓毒症或脓毒性休克、MELD评分与ACLF死亡密切相关。用受试者工作特征(receiver operating characteristic,ROC)曲线分析显示,MELD和APACHEⅡ评分系统曲线下面积(area under curve,AUC)分别为0.947和0.876。结论高MELD分值和APACHEⅡ评分与ACLF患者病死率独立相关,对ACLF患者的预后有独立预测能力。MELD评分系统在预测我国慢加急性肝衰竭患者预后方面有更好的临床价值。

Objective To investigate the MELD and APACHE Ⅱ score in predicting the prognosis of patients with acute-on-chronic liver failure（ACLF）. Methods A retrospective study of 104 ACLF patients between June 2003 and June 2006 were employed. The MELD and APACHE Ⅱ score were used to compare the differences between survivors and nonsurvivors. Results The MELD and APACHE Ⅱ score in nonsurvivors were significantly higher than those of survivors （both P〈0.01）. And the area under ROC curve was 0. 947 and 0. 876 respectively for MELD and APACHE Ⅱ score. Conclusion MELD and APACHE Ⅱ score can be used to predict outcome in patients with ACLF. MELD is better.