三种评分方法预测肝硬化并食管静脉曲张破裂再出血风险的价值比较

A comparative study of three prognostic systems for rebleeding in decompensated liver cirrhotic patients with esophageal varices

目的 比较终末期肝病模型（MELD）、MELD-Na及Child-Pugh评分对失代偿期肝硬化并食管静脉曲张破裂出血患者3个月及1年内再出血风险的预测价值.方法 回顾性分析2003年1月至2008年10月收治的病历资料失代偿期肝硬化并食管静脉曲张破裂出血患者365例并随访1年.将患者分为低钠血症组与血钠正常组,记录每例患者入院第1天的MELD-Na、MELD、Child-Pugh评分,随访患者在3及12个月内的再出血情况,绘制受试者工作特征（ROC）曲线并计算曲线下面积（AUC）,比较MELD-Na、MELD、Child-Pugh评分三者预测再出血风险的准确率,并应用正态Z检验对三者曲线下面积进行比较.结果 MELD-Na和MELD预测患者3个月内再出血风险的AUC分别为0.825和0.779,预测1年内再出血风险的AUC则分别为0.842和0.802,均高于Child-Pugh评分（0.678和0.634,P值均＜0.05）,但MELD-Na和MELD间差异无统计学意义（P＞0.05）.结论 MELD-Na及MELD均能预测失代偿期肝硬化并食管静脉曲张破裂出血患者再出血风险,且均优于Child-Pugh评分.MELD-Na弥补了MELD的部分不足.

Objective To compare the predictive value of the model for end-stage liver disease （MELD）, MELD-Na and Child-Pugh （CP） for rebleeding in decompensated liver cirrhosis patients with esophageal varices within 3-month and 1-year. Methods A cohort of 365 decompensated liver cirrhotic patients with esophageal varices, who were admitted to hospital between Jan.2003 and Oct.2008, were retroseptively studied and followed up at least for one year. Patients were divided into hyponatremia group and normal group. MELD-Na, MELD and Child-Pugh scores were calculated for each patients on the first day of admission.Receiver operating characteristics curves （ROC） and the area under ROC （AUC） were used to determine the ability of three models for predicting rebleeding in 3-month and 1-year. Z-test was used to compare predictive ability of three models. Results At 3-month and 1 year of enrollment, AUC of MELD-Na was 0.825 and 0.842, respectively, whereas AUC of MELD was 0.779 and 0.802, respectively. MELD-Na and MELD were superior to Child-Pugh in rebleeding prediction （0.678 and 0.634, P〈0.05）. But there was no significantly difference between MELD-Na and MELD in rebleeding prediction for 3-month and 1-year （P〉 0.05）. Conclusions MELD-Na and MELD are superior to Child-Pugh score in exactly predicting the rebleeding risk in decompensated liver cirrhosis patients with esophageal varices. MELD-Na compensates a deficiency of MELD.