终末期肝病模型评估肝硬化食管静脉曲张破裂大出血硬化治疗预后价值的比较

Models of end-stage liver disease in evaluating the prognosis of cirrhosis patients after endoscopic injection sclerotherapy

目的评价CTP、终末期肝病模型（MELD）、MELD—AS、MELD．Na、i-MELD以及MESO在判断肝硬化食管静脉曲张破裂出血行内镜下硬化治疗术（EIS）患者预后方面的价值。方法在行急诊EIS的肝硬化食管静脉曲张破裂大出血患者中，选取有完整临床资料和随访结果的78例患者进行回顾性分析，应用受试者工作特征（ROC）曲线及曲线下面积评价上述各模型在判断行急诊EIS患者预后的准确性。获取各模型判断患者预后的最佳临界值。结果78例患者中随访6、12个月，分别死亡8例（10．26％）、11例（14．10％）。在随访6、12个月中，生存患者与死亡患者年龄、性别构成比较差异无统计学意义。判断患者预后时，ROC曲线下面积值大于0．800的模型，6个月为MELD-AS（O．837）、MESO（0．830）、MELD（0．830）、MELD-Na（0．818）；12个月为MELD（0．822）、MELD-AS（0．821）、MESO（0．814）。结论MELD．AS、MESO及MELD在判断急诊EIS患者6、12个月的预后方面准确度较高，是该类患者中短期死亡风险的较好判断指标，亦可作为临床EIS术前的筛选指标，具有一定的临床指导意义。

Objective To evaluate CTP,MELD,MELD-AS,MELD-Na,i-MELD and MESO in prognosis of cirrhosis patients who underwent endoscopic injection sclerothempy （EIS）. Methods Seventy- eight cirrhosis patients with integral clinical and follow-up data were enrolled into the study. The area under the receiver operating characteristic （ROC） curve （AUC） was used to compare these six models in predicting mortality risk. The optimal threshold of them to determine the prognostic death risk was calculated by ROC curves. Results Eight patients died within half one year, 11 patients died within the first year. There was no significant difference in gender and age between the survival and death groups. The AUC of the six models higher than 0.800 were that, 6-month ： MELD-AS （0.837）, MESO （0.830）, MELD （0.830） ; 12-month ： MELD （0.822）,MELD-AS （0.821）,MESO （0.814）. Conclusions MELD-AS,MESO,MELD and so on are all accurate predictive systems fi）r 6-month and 12-month of patients who underwent EIS. The value of them are very important in the selection of patients for EIS, and have a certain clinical significance.