终末期肝病模型评估血浆置换治疗慢性重型肝炎的疗效及预后

Model for end-stage liver disease in assessing the effect of plasma exchange on prognosis of patients with chronic severe hepatitis

目的探讨终末期肝病模型(MELD)评分对血浆置换治疗慢性重型肝炎的疗效和对短期预后的预测能力。方法 210例慢性重型肝炎患者被分成血浆置换组(85例)和对照组(125例),观察两组在治疗前与治疗后2周MELD评分及3个月时的病死率的变化。采用受试者工作特征(ROC)曲线及曲线下面积评价MELD评分系统的准确性。结果治疗后2周,两组MELD评分均有明显的降低(P<0.01),但在MELD>40的患者,则无明显降低;PE组患者病死率(49.4%)低于对照组(64.8%,P<0.05),在MELD≤39的患者,两组病死率差异有统计学意义(P<0.01);对照组最佳MELD临界值为26,其敏感度为80.2%,特异度为79.5%,准确性为80.0%,而PE组为30,其敏感度为76.2%,特异度为69.8%,准确性为72.9%。结论 MELD评分能较准确地预测慢性重型肝炎患者的短期预后。

Objective To study the effect of plasma exchange on the short term prognosis in patients with chronic severe hepatitis using model for end-stage Iiver disease（MELD）score.Methods 210 patients with chronic severe hepatitis were divided into PE group（n=85）and control group（n=125）.The MELD scores and the death rates within 3 months were observed.The validity of MELD was determined by ROC curves and area under the curve（AUC）.Results The MELD scores were decreased in patients with MELD less than 39 after treatment in the two groups（P〈0.01）;The mortality rate in PE group（49.4%）was lower than that in contml（64.8%,P〈0.05）;There were no significant difference in patients with MELD≥40（P〉0.05）;The optimal cut-off value of MELD to predict the prognosis of patients in control group was 26,and its sensitivity,specificity and accuracy were 80.2%,79.5% and 80.0%,respectively,while in PE group they were 30,76.2%,69.8% and 72.9%,respectively.Conclusions MELD score is able to accurately predict the short-term prognosis of patients with chronic severe hepatitis.