终末期肝病模型评估肝硬化失代偿期患者的短期预后

Evaluation of model for end stage liver disease for estimation of short-term prognosis in decompensated cirrhosis

目的评价终末期肝病模型(MELD)、MELD-Na、Child-Turcotte-Pugh(CTP)和包含血肌酐值的CTP(CrCTP)评分对肝硬化失代偿期患者短期预后的价值。方法选择265例具有完整住院资料和随访结果的肝硬化失代偿期患者为研究对象,分别计算每例患者人院后首次MELD、MELD-Na、CTP及CrCTP评分,并了解其3个月内的病死率。以受试者工作特征曲线(ROC)下面积(AUC)衡量各评分系统判断患者3个月生存的能力。结果 3个月内有58例死亡。死亡组MELD、MELD-Na、CTP及CrCTP分值(分别为22.15±5.67、31.45±8.50、11.60±2.70、12.72±2.54)均高于生存组(分别为12.35±3.56、17.24±4.75、8.73±2.35、9.05±2.50)(P<0.01),两组在MELD分值和CTP分级的分布上差异具有统计学意义(P<0.01)。MELD、MELD-Na、CTP及CrCTP评分对肝硬化失代偿期患者3个月预后评估的ROC曲线下面积分别为0.875、0.868、0.758、0.794,MELD评估患者短期预后价值优于CTP评分(P<0.05),MELD与MELD-Na、CrCTP评分差异无统计学意义。结论 MELD、MELD-Na、CTP及CrCTP模型均可有效预测肝硬化失代偿期患者的短期预后;MELD评估患者短期预后价值优于CTP;在CTP中引入血肌酐值即CrCTP评分可以提高对患者短期预后判断力。

Objective To evaluate the short-term prognostic value of model of end stage liver disease（MELD）,MELD-Na,Child-Turcotte-Pugh（CTP） and the creatinine modified CTP（CrCTP） grading in patients with decompensated liver cirrhosis.Methods 265 patients with decompensated liver cirrhosis were enrolled in the study.The MELD,MELD-Na,CTP and CrCTP scores were calculated for each patient on the first time of admission and their mortality within 3 months was observed.Receiver operating characteristic curve（ROC） and the area under the curve（AUC）were used to analyze and compare the values of the four models to predict the 3-month survival.Results 58 patients died within 3 months.MELD,MELD-Na,CTP and CrCTP scores for non-survivors（22.15±5.67,31.45±8.50,11.60±2.70,12.72±2.54）were significantly higher（P0.01） than those for survivors（12.35±3.56,17.24±4.75,8.73±2.35,9.05±2.50）.There were significant differences between the two groups in MELD and CTP grade（P0.01）.For 3-month predictive prognosis,the area under ROC of MELD,MELD-Na,CTP and CrCTP were 0.875,0.868,0.758 and 0.794 respectively.MELD was superior to CTP in predicting short-term of patients with decompensated liver cirrhosis.There was no difference between MELD,MELD-Na and CrCTP.Conclusion MELD,MELD-Na,CTP and CrCTP scores can accurately predict the 3-month survival of patients with decompensated liver cirrhosis.The MELD score is superior to CTP score for estimation of short-term survival in patients with decompensated cirrhosis.