四种评分模型对慢性重型乙型肝炎患者短期预后的比较

Comparison of four scoring models in predicting short-term prognosis of chronic severe hepatitis B patients

目的比较四种评分模型(MELD、MELD-Na、SMSVH及CTP)对慢性重型乙型肝炎患者短期预后的预测价值。方法记录住院后确诊慢性重型乙型肝炎85例患者的临床指标并随访3个月的生存情况,分为生存组和死亡组,并用MELD、MELD-Na、SMSVH和CTP评分模型进行评分。应用受试者工作特征曲线(ROC)评价每一个模型的预测能力,根据各自的最佳临界值用Kaplan-Meier(K-M)分析患者生存时间、生存率,并算出总预测正确率。结果死亡组MELD-Na、MELD、SMSVH和CTP的平均分值明显高于生存组(P<0.01)。四者ROC曲线下面积分别为0.848、0.833、0.802和0.75。四者的预测能力比较,差异无统计学意义(χ2=6.64,P=0.084)。四者的总预测正确率分别为(82.35%、77.64%、77.65%、71.76%),差异亦无统计学意义(χ2=2.737,P=0.434)。结论 MELD、MELD-Na、SMSVH和CTP评分模型对慢性重型乙型肝炎患者短期预后判断有较好的作用,四种评分模型预测价值无统计学差异,四者预测价值相当。

Objective Compare the clinical values of four scoring models,including the model for endstage liver disease（MELD）,MELD-Na,Scoring model of severe viral hepatitis（SMSVH） and Child-Turcotte-Pugh（CTP） scoring models,to predict the short-term prognosis of the patients with chronic severe hepatitis B.Methods Clinical information of 85 inpatient patients with chronic severe hepatitis B were recordedand followed up for 3 months.The patients were then divided into survival group and death group.All the patients were evaluated according to MELD,MELD-Na,SMSVH and CTP scoring models.The receiver operating characteristic curve（ROC） were used to compare the predictive ability of each model.Estimate the survival time and the survival rate by Kaplan-Meier（K-M） method and calculatethe total predictive agreement rate according to respective optimum cut-off value.Results The average scores of MELD-Na,MELD,SMSVH and CTP scoring models in the death group were greater than that in the survival group（P 0.01）.The area under the curve（AUC） were 0.848,0.833,0.802 and 0.752 respectively.There were no difference of the predictive power and total predictive agreement rates of four models（χ2 = 6.64,P = 0.084）（χ2 = 2.737,P = 0.434）.The total predictive agreement rates of four models were 82.35%,77.64%,77.65% and 71.76% respectively.Conclusion MELD-Na,MELD,SMSVH and CTP scoring models has better effect in predicting short-term prognosis of the patients with chronic severe hepatitis B.There were no significant differences in predictive power.The clinical value of four scoring models were approximate.