终末期肝病模型在评估慢性重型肝炎预后中的应用

Application of Model for End-stage Liver Disease in Assessing the Prognosis of the Patients with Chronic Severe Hepatitis

目的探讨终末期肝病模型(MLED)评分系统对慢性重型肝炎患者短期(3个月)预后的预测能力及其临床应用价值。方法应用MELD模型公式对125例慢性重型肝炎患者进行评分,观察其3月内的死亡率,以受试者工作特征(ROC)曲线和曲线下面积评价该系统预测患者短期(3个月)预后的准确性,并求出作为判断患者3个月内死亡与否的MELD最佳临界值。结果 81例(64.8%)患者在3个月内死亡,死亡组MELD分值(34.6±10.5)明显高于存活组(23.5±5.8)(P<0.001);MELD<20、20≤MELD<30、30≤MELD<40及MLED≥40的患者病死率分别为14.3%、54.9%、79.5%和95.2%;应用该模型预测患者3个月内死亡与否的最佳MLED临界值为26,c-统计值为0.802,敏感度为80.2%,特异度为79.5%,准确性为80.0%。结论患者短期内(3个月)死亡的危险性随其MELD分值的增加而上升,MELD模型对慢性重型肝炎患者的病情及预后有很好的预测价值。

Objective To study the clincal pratical use of the model for end-stage liver disease （MELD） and assess its validity in predicting the prognosis of patients with chronic severe hepatitis. Methods 125 patients with chronic severe hepatitis were graded with MELD formula. The motality rates was observed within three months. The validity of MELD was determined and the optimal cut-off values of the model to discriminate between deceased and surviving patients were calculated by ROC curves and area under the curve. Results 81 patients （64.8%） died within 3 month. MELD score of non-survivors （34.6 ±10.5 ） was higher than that of survivors （23.5 ±5.8） significantly （ P 〈 0. 001 ）. The mortality rates of patients whose MELD 〈 20,20 ≤MELD 〈 30,30 ≤ MELD 〈 40 and MLED ≥40 were 14.3% , 54.9% , 79.5% and 95.2% respectively. The optimal cut-off values of MELD to predict the prognosis of patients was 26, whose c-statistic, sensitivity, specificity, accuracy and were 0. 802, 80.2%, 79.5% and 80.0% respectively. Conclusion The mortality of the patients increase with the increase of their MELD scores. The MELD can aeem＇ately predict the short-tern1 prognisis of patients with chronic sever hepatitis.