应用MELD-Na模型评估失代偿期肝硬化患者的短期预后

Application of MELD-Na Model in Predicting the Short-term Prognosis of Patients with Decompensated Liver Cirrhosis

目的评估终末期肝病血清钠(MELD-Na)、终末期肝病模型(MELD)及Child-Pugh评分系统对失代偿期肝硬化患者短期预后的预测价值。方法对具有完整记录和随访结果的96例失代偿期肝硬化患者的资料进行分析,分别计算每例患者的Chlid-Pugh、MELD及MELD-Na分值,使用受试者工作曲线(ROC)及曲线下面积(AUC)比较3种评分系统判断失代偿期肝硬化患者生存3个月的准确性。结果 96例患者3个月内有25例患者死亡。死亡组的Child-Pugh、MELD及MELD-Na评分均高于生存组(P<0.01);MELD-Na和MELD评分在判断患者3个月生存时间的ROC曲线AUC均大于Child-Pugh(P<0.001,P<0.01),MELD-Na和MELD评分AUC差异均无统计学意义(P>0.05)。结论 MELD-Na是判断失代偿期肝硬化患者短期预后的一个较好指标,其准确性优于Child-Pugh分级,但与MELD评分相比无明显差异。

Objective To evaluate the clinical value of the MELD-Na, model for end-stage liver disease （MELD） and Child-Pugh scoring system in predicting the short-term prognosis of patients with deeompensatd liver cirrhosis. Methods A co- hort of 96 patients with decompensated liver cirrhosis were retrospectively studied and follewed up at least for period of 3 months. The Child-Pugh, MELD and MELD-Na scores were calculated according to the clinical data for each patient to compare their val- ues in prognosis. Receiver operating characteristic curve（ROC） and the area under the curve（AUC） were used to measure the accuracy of the three models to predict the 3-month survival. Results 30 patients died with in 3 months. Whose Child-Pugh, MELD and MELD-Na scores were higher than those of survivors significantly（ P 〈 0. 01 ）. The area under ROC of MELD-Na and MELD score were higher than that of Child-Pugh score respectively（ P 〈 0. 001, P 〈 0. 01 ）. The difference of AUC between the MELD-Na and MELD score was not significant in preding survival（ P 〉0. 05）. Conclusion MELD-Na is a useful prognosis in- dictor for the decompensated liver cirhosis. The MELD-Na score is superior the Child-Pugh score and similar to MELD score in predicting the short-term prognosis of patients with deeompensated liver cirrhosis.