MELD和MELD-Na评分系统评估失代偿期肝硬化患者预后的研究

The predicting value of model for end-stage liver disease(MELD) and MELD-Na for shot-term prognosis of patients with decompensated cirrhosis

目的比较Child-Pugh(CTP)分级、终末期肝病模型(Model for End-stage Liver Disease,MELD)评分系统及MELD联合血清钠(MELD-Na)对失代偿期肝硬化患者3、6、12个月死亡危险的预测价值。方法入选151例肝硬化失代偿期患者,根据随访3、6、12个月的存活情况,分别观察CTP分级、MELD评分及MELD-Na对肝硬化失代偿期患者死亡率的预测情况。结果151例入选病例中,随访至3个月时,不论是CTP、MELD还是MELD-Na随着各相应分值的增高,生存率均显著降低(P<0.01),提示CTP、MELD及MELD-Na均能较好地预测患者短期生存率。随访至6个月及12个月时患者生存率的变化仍可见到这种趋势。本研究应用C-统计学分析,通过CTP、MELD及MELD-Na对比发现,随访至3个月时,CTP、MELD、MELD-Na的AUC分别为0.819、0.835、0.842;随访至6个月时AUC值为0.820、0.818、0.832;随访至12个月时AUC分别为0.795、0.795、0.814。MELD-Na的数值均高于CTP及MELD,但统计学无显著差异。结论CTP、MELD和MELD-Na均可以对终末期肝病患者预后做出较准确的判断。MELD-Na在预测肝硬化失代偿期患者短期生存率方面有一定优势。

Objective To compare the predicting value of Child-Pugh（CTP）,model for end-stage liver disease（MELD） score and MELD-Na score for the prognosis of patients with decompensated cirrhosis in 3 months,6 months and 12 months.Methods One hundred and fifty-one patients with decompensated cirrhosis were enrolled and followed up for 3 months,6 months and 12 months to evaluate the predicting value of CTP,MELD and MELD-Na for survival rate.Results With the increasing of scores of CTP,MELD and MELD-Na,the survival rate was dramatically decreased during the first 3 months（P〈0.01）,respectively.These trends could still be observed during 6 months and 12 months follow up.In 3 months,area under the ROC（AUC） of CTP,MELD and MELD-Na were 0.819,0.835 and 0.842,respectively.Then 0.820,0.818 and 0.832 in 6 months;0.795,0.795 and 0.814 in 12 months.The AUC of MELD-Na was higher than that of CTP or MELD,however,the difference did not reach statistical significance.Conclusion All of CTP,MELD and MELD-Na can predict the short-term prognosis of patients with decompensated cirrhosis quite well.MELD-Na score has limited advantage over CTP or MELD score.