终末期肝病模型评分对慢性重型肝炎患者分子吸附循环系统疗效及预后的评价

MELD scoring system in evaluating the curative effect of MARS and prognosis of the patients with chronic severe hepatitis

目的探讨终末期肝病模型(MELD)评分系统对分子吸附循环系统(MARS)治疗慢性乙型重型肝炎患者疗效及短期预后的预测能力及其临床应用价值。方法对60例MARS治疗的慢性乙型重型肝炎患者,应用MELD评分系统对患者进行评分,比较治疗后3个月内的病死率,受试者工作特征(ROC)曲线评价MELD评分系统的准确性。结果根据MELD分值不同将患者分为3组:MELD≤30分、30分<MELD<40分和MELD≥40分,3组患者的病死率分别为20.0%、34.3%和94.4%,3个月病死率随MELD分值增高而增高,前两组患者的病死率显著低于第三组,差异有统计学意义(P<0.05)。MELD≤30分和30分<MELD<40分两组患者在MARS治疗前后实验室各项检测指标比较差异有统计学意义(P<0.05)。MELD分值在≤30分和30分<MELD<40分两组患者的半数生存率均超过3个月,MELD分值达到或超过40分患者的半数生存率在1.54个月,生存率差异有统计学意义(P<0.05)。患者入院时MELD分值能够非常好地预测患者3个月内的病死率,应用MELD评分系统判断MARS治疗患者3个月预后的ROC曲线,其C-统计值为0.789,最佳临界值32,相应的敏感性80.1%,特异性50.1%。结论MELD评分系统能较准确预测慢性重型肝炎患者的短期临床预后,MELD分值能够作为反映慢性重型肝炎患者病情严重程度的指标,MARS治疗可提高部分慢性重型肝炎患者的短期生存率。

Objective We analyze the curative effect of MARS treatment in chronic severe hepatitis B patients and the prediction accuracy of the short term prognosis using the MELD score. Methods Sixty chronic severe hepatitis B patients are analyzed using MELD score in our study, and the risk of death within 3-month were compared. ROC curve was used to analyze the prediction accuracy. Results Patients were divided into three categories according to the MELD score： MELD≤30, 30MELD40 and MELD≥40. Patients having a MELD≤30, 30MELD40 and MELD≥ 40 experienced a mortality 20.0%, 34.3% and 94.4%, respectively, the 3-month mortality rises as the MELD score increases, there is significant difference in mortality among the three groups （P0.05）. There are significant differences in examinations before and after MARS treatment between the MELD ≤30 and 30MELD 40 group （P0.05）. Fifty percent of the patients whose MELD is less than 40 survived longer than 3 months. Half of the patients whose MELD were 40 and over than 40 survived only for 1.54 months. MELD score is able to accurately predict the 3-month survival of the patients, the C-statistic for the MELD score’s prediction of 3-month survival is 0.789, the best cutoff value is 32, sensitivity is 80.1%, specificity is 50.1%. Conclusions MELD score is able to accurately predict the short term prognosis of the patients with chronic severe hepatitis. MELD score is an index of severity of chronic severe hepatitis and markers of advanced stages. MARS treatment is able to improve the short term survival of some chronic severe hepatitis patients.