血清总胆固醇水平与MELD评分评估失代偿期乙肝肝硬化患者预后

The value of serum total cholesterol and MELD score in predicting the prognosis of patients with decompensated liver cirrhosis caused by hepatitis B virus

目的探讨血清总胆固醇(TC)水平与终末期肝病模型(MELD)评分对乙肝肝硬化失代偿期患者的短中期预后的预测价值。方法入选77例乙肝肝硬化失代偿期患者,分别根据随访3个月、6个月的存活情况分组,对死亡组与存活组中血清总胆固醇值、MELD评分及CTP分值进行比较;应用ROC曲线评价血清总胆固醇浓度、MELD评分及CTP评分对失代偿期乙肝肝硬化患者预后的预测能力。结果随访至3个月、6个月,死亡组血清胆固醇值显著低于存活组,MELD评分及CTP分值显著高于存活组,且均具有统计学意义(P<0.01)。MELD评分与血清胆固醇密切相关(r=-0.353,P=0.002)。CTP评分、MELD评分及血清总胆固醇对失代偿期乙肝肝硬化患者3个月及6个月预后评估的ROC曲线下面积分别为0.725、0.898、0.768及0.753、0.898、0.769。结论 CTP评分、MELD评分和血清总胆固醇值是预测乙肝肝硬化失代偿患者3个月、6个月生存率较好的独立的预后指标;血清胆固醇值在预测乙肝肝硬化失代偿患者短、中期病死率方面有一定的作用,且其经济、方便、实用,较适用于基层医院。

Objective To evaluate the prognostic value of the serum total cholesterol（TC） and model for end-stage liver disease（MELD） in patients with decompensated cirrhosis caused by hepatitis B virus.Methods A total of 77 patients with decompensated cirrhosis caused by hepatitis B virus were enrolled into the study and were followed up for 6 months.Patients were divided into the survival group and the death group at 3 month and 6 month.TC,MELD and Child-Turcotte-Pugh score（CTP） were campared between the groups.Prediction of mortality was analyzed using the area under the receiver＇s operating characteristics（ROC） curve（AUC）.Results The TC was lower in death group at 3 month and 6 month.The MELD and CTP were higher in death group at 3 month and 6 month.There was significant difference between the two groups（P〈0.01）.The MELD score was significantly correlated with TC levels（r=-0.353,P=0.002）.The AUC of CTP,MELD and TC were 0.725,0.898,0.768 at 3 month and 0.753,0.898,0.769 at 6 months.Conclusion The CTP,MELD and TC were independent risk factors for prognosis of decompensated cirrhosis caused by hepatitis B virus.All of them can predict the short and medium-term mortality,but TC has promising value for predicting the short and medium-term prognosis in patients with discompensated hepatic cirrhosis,which is economical,convenient,practical and is suit for local hospitals.