终末期肝病模型在中医药治疗失代偿期肝硬化患者时的应用价值

MELD scores and prognosis of patients with decompensated liver cirrhosis treated by traditional Chinese medicine

目的：评估终末期肝病模型（MELD）评分系统在失代偿期肝硬化患者中医参与治疗中的应用价值。方法：对92例失代偿期乙型肝炎肝硬化住院患者中医药参与治疗后进行MELD评分。随访3个月、12个月、24个月的生存率，并分组比较。结果：随访3个月病死率30．4％；12个月病死率38．0％；24个月病死率为75．0％。以MELD系统R为18分组比较显示：〉18分组3个月、12个月的病死率明显高于≤18分组（P=0．001及0．006），24个月时则无明显差异：以R≤9分、10～19分、20—29分、30—39分、≥40分组比较，显示R≤9分组12个月的病死率为0，≥40分组3个月病死率100％，10分以上者24个月均有较高的病死率。结论：MELD对失代偿期肝病1年内的短期预后的判定较为准确，中医药参与治疗可能获得较为理想的远期较果。

Objective： To evaluate the applicability of the model for end-stage liver disease （MELD） scoring system in patients with end-stage liver disease treated by traditional-Chinese-medicine （TCM） -involved therapy. Methods： Ninety-two inpatients with decompensated cirrhosis due to hepatitis B who received TCM-months and then compared. Results： The mortality at 3-, 12-and 24-months was 30.4% , 38.0% and 75.0%, respectively. Compared with those with R≤18, patients with a score of R 〉 18 had significantly higher mortality at 3-and 12-months （P = 0. 001 and 0. 006, respectively） . No significant differences in mortality at 24 months were observed between these two groups. Comparisons of patients with a score of≤9, 10 - 19, 20 -29, 30 -39, or ≥40 showed a mortality of 0 at 12 months for those with R ≤9 and of 100% at 3 months for those with R /〉40; patients with R≥ 10 had a highmortality at 24 months. Conclusion： The MELD scoring system may accurately predict the short-term prognosis for patients who suffer from decompensated liver cirrhosis for no more than t year. A more desirable long-term effect may be achieved by the TCM-involved therapy.