肝脏储备功能相关系统对肝硬化失代偿期预后的评估与分析

Liver reserve function for assessing and analyzing prognosis of decompensated hepatocirrhosis

目的运用终末期肝病模型（MELD）评分与CTP分级等对失代偿期肝硬化患者短期生存状况进行相关性回顾性分析，预测失代偿期肝硬化患者3个月、1年的病死率。方法应用MELD、MELD—Na计算公式及CTP分级分别对119例肝硬化失代偿期患者进行评分及分级，比较不同MELD评分（≤9、10～19、20～29、≥30分）组及CTP不同分级患者（A、B、C级）3月和1年的病死率，并分析肝硬化失代偿期患者随访3月、1年预后的临床特征。结果MELD评分≤9、10～19、20．29、≥30分者，3个月内死亡率分别为：2．17％，10．71％、64．29％和100％；1年病死率分别为：26．09％、32．14％、57．14％和100％，各组间差异有显著性（3月组P〈0．05，1年组P〈0．01）。表明肝硬化失代偿期患者短期（3月与1年）病死率与MELD分值有关。以R〉18分为界分组比较3月、1年的病死率，结果显示〉18分的3月、1年病死率明显高于≤18分组，差异有极显著性（两组P〈0．01）。CTP分级显示：A、B、C级3个月内各组死亡率分别为6．78％、15．38％、42．86％，各组差异有极显著性（P〈0．01）。

Objective To retrospectively analyze the short-term survival status of decompensated hepatocirrhosis by the Model for End-Stage Liver Disease （ MELD ） and Child-Turcotte-Pugh （ CTP ） score and to predict 3-month and one-year mortality rates in decompensated hepatocirrhosis. Methods MELD, MELD-Na, and CTP score decompensated hepatocirrhosis were used to classify and graded decompensated hepatocirrhosis in 119 patients.The 3-month and one-year morality rates were compared among patients with different MELD scores （ ≤9, 10-19, 20-29, and ≥30 ） or different CTP classification （ A, B, and C ）. The clinical features were analyzed in the patienes during a 3- month and a one-year follow-up. Results The 3-month mortality rate was 2.17 % for MELD ≤ 9, 10.71% for 10-19, 64.29 % for 20-29, and 100 % for I〉30; and the one-year mortality was 26.09%, 32.14%, 57.14 %, and 100 %, respectively. The short-term mortality was associated with MELD scores. If R 〉 18 was used as a standard, the 3-month and one-year mortality rates were significantly higher in the group with R 〉 18 than in the group with R= 18 （ P〈 0.01 for both comparisons ）. The 3-month mortality rate was 6.78 % for CTP A, 15.38 % for B, and 42.86 % for C （ P〈 0.01 and the one-year mortality was 11.86 %, 38.46 %, and 90.48 %, respectively （ P〈 0.05 ）. MELD-Na was related to the short-term mortality （ 3 months and 1 year ） in decompenated hepatocirrosis （ P 〈 0.01 ）. Conclusions Both MELD and CTP scores can accurately predict the short-term prognosis in patients with decompensated hepatocirrhosis.