终末期肝病血清钠评分联合血清内毒素和胆固醇对肝硬化失代偿期患者预后的判断价值

MELD-Na score combined with serum cholesterol and endotoxin concentration on the evaluation of the decompensated liver cirrhosis prognosis

目的探讨终末期肝病血清钠（MELD-Na）评分联合血清内毒素、胆固醇对肝硬化失代偿期患者预后的判断价值。方法回顾性分析失代偿期肝硬化住院患者156例的临床资料，分别根据随访6、12、24个月的生存、死亡情况分组，通过测定相关指标计算存活组与死亡组患者MELD-Na分值，测定血清内毒素、胆固醇浓度，分析MELD-Na分值联合血清内毒素、胆固醇浓度与肝硬化失代偿期患者预后相关性。结果随访6个月，19例死亡；随访12个月，59例死亡；随访24个月，77例死亡。6、12、24个月存活组与死亡组患者MELD—Na分值、血清内毒素、血清胆固醇浓度之间的差异均有统计学意义（t值分别为-9．68、-9．22、11．40，-4．65、-19．60、16．20，-20．0、-18．7、17．3，P均〈0．05）。MELD．Na分值预测失代偿期肝硬化患者死亡的最佳临界值为32分，MELD．Na分值增高患者死亡风险也增加；血清内毒素预测患者死亡的最佳临界值为≥12ng／L，血清胆固醇预测患者死亡的最佳临界值为≤1．70mmol／L，血清胆固醇降低、内毒素浓度增高可增加患者死亡风险。结论MELD．Na评分联合血清内毒素、胆固醇浓度对肝硬化失代偿期患者预后有较高的判断价值。

Objective To evaluate the prognosis of the decompensated liver cirrhosis by means of MELD-Na score combined with serum cholesterol and endotoxin concentration. Methods Data of 156 hospitalized patients with decompensated liver cirrhosis was retrospectively analyzed. Patients were divided into survival and death group according to follow-ups at 6 months, 12 months and 24 months. MELD-Na score was made among 156 patients by detecting relevant indicators. Serum cholesterol and cholesterol levels were measured,too. The relationship between decompensated liver cirrhosis prognosis and MELD-Na score combined with serum cholesterol and endotoxin concentration was analyzed. Results Ninteen patients died at the follow-up for 6 months. Fifty nine patients died at the followe-up for 12 months. Seventy seven patients died at the follow-up for 24 months. There was significant difference on MELD-Na score, endotoxin concentration and serum cholesterol between the survival group and the death group （t = - 9. 68, - 9. 22,11.4, - 4. 65, - 19. 60,16. 20, - 20. 0, -18.7,17.3, respectively,P 〈 0.05 ）. The best critical value of M ELD-Na score to predicate death in patients with decompensated liver cirrhosis was 32 points. The risk of death would rise if MELD-Na score increased. The best critical value of plasma endotoxin to predicate death in patients with decompensated liver cirrhosis was ≥ 12 ng/L. The best threshold value of serum cholesterol to predict death in patients with decompensated liver cirrhosis was ≤ 1.70 mmol/L. Conclusion MELD-Na score, serum cholesterol and serum endotoxin were of higher prognostic value to judge the prognosis of patients with decompensated liver cirrhosis.