改良终末期肝脏疾病模型对慢性乙型重型肝炎预后的评估

Model for end-stage liver disease-sodium predicts prognosis in patients with chronic severe hepatitis B

目的探讨改良终末期肝脏疾病模型（MELD—Na）在慢性乙型重型肝炎患者的预后评估与治疗策略的制定中的意义。方法回顾性分析2007年1月至12月单一中心426例慢性乙型重型肝炎患者的临床资料，分析患者入院时的血清Na＋浓度、MELD值、MELD-Na值和接受治疗2周后的MELD—Na值与入院时MELD—Na值的差值（AMELD-Na分值）与患者3个月病死率的关系，以c-statistic评价各模型的预测准确性。结果患者人院时的血清Na＋浓度、MELD值和MELD—Na值预测慢性乙型重型肝炎患者3个月病死率的c-statistic分别为0．718、0．875和0．922。MELD-Na≥40组、35〈MELD—Na〈40组、30〈MELD．Na≤35组、25≤MELD-Na≤30组和MELD—Na〈25组的3个月病死率分别为86．9％、53．8％、35．4％、5．4％和2．0％，各组间病死率差异有统计学意义（P〈0．05）；AMELD．Na〉0组和≤0组的病死率分别为65．9％和15．8％，两组间病死率差异有统计学意义（P〈0．05）。结论MELD—Na能准确预测慢性乙型重型肝炎患者的预后，AMELD-Na值是临床工作中预测慢性乙型重型肝炎患者治疗效果的一个良好参数。

Objectives To study the practical use of the serum sodium incorporated model for endstage liver disease （MELD-Na） on clinic and to assess its validity by the concordance-statistic in predicting the prognosis of the patients with chronic severe hepatitis B. Methods Adult patients with a diagnosis of chronic severe hepatitis B between January 2007 and December 2007 in a single center were analyzed. The serum sodium, MELD, MELD-Na, and AMELD-Na （ AMELD = MELD score at 14 days after medical treatment-MELD score at admission ） scores of 426 patients with chronic severe hepatitis B were calculated. The 3-month mortality in patients was measured, and the validity of the models was determined by means of the concordance-statistic. Results The area under the receiver-operating characteristic curves of Na, MELD and MELD-Na for the occurrence of death in 3 month were 0. 718,0. 875 and 0. 922. The 3-month mortality of the MELD-Na scores group 〈 25,25-30, 〉 30-35, 〉 35- 〈 40 and ≥ 40 were 2. 0%, 5.4%, 35.4% , 53.8% and 86. 9% respectively. There was a significant difference of 3-month mortality between the five groups （ P 〈 0. 05 ）. The 3-month mortality of AMELD-Na 〉 0 group was 65.9% , and the AMELD-Na ~〈0 group was 15.8%. There was a significant difference of 3-month mortality between the two groups （P 〈 0. 05）. Conclusions MELD-Na score is a valid model to predict 3-month mortality in patients with chronic severe hepatitis B. AMELD-Na is clinically useful parameters for predicting the therapeutic effect of chronic severe hepatitis B.