终末期肝病模型评分与Child-Turcotte-Pugh评分对肝硬化患者手术预后的评估

Evaluation of the model for end-stage liver disease and Child-Turcotte-Pugh score on the surgical prognosis in patients with liver cirrhosis

目的研究终末期肝病模型（MELD）评分及Child-Tureotte-Pugh（C即）评分对肝硬化患者手术预后的评估。方法入选70例行脾切除＋门奇断流术的肝硬化患者，计算术前MELD评分和CTP评分，分析两者相关性及不同分组下并发症的发生情况。以受试者工作特征（ROC）曲线下面积衡量各评分的预测能力。结果共23例（32．9％，23／70）发生术后并发症。并发症组（23例）MELD评分和CTP评分分别为（19．58±5．90）分和（8．84±1．87）分，无并发症组（47例）分别为（12．27±2．94）分和（6．10±1．12）分，两组比较差异有统计学意义（P〈0．01）。将患者按MELD评分进行分组：〈14分组（30例）、14～23分组（28例）、〉23分组（12例），三组并发症发生率分别为10．0％（3／30）、35．7％（10／28）和83．3％（10／12），三组并发症发生率两两比较差异均有统计学意义（P〈0．05）。将患者按CTP评分进行分级：A级（29例）、B级（25例）和C级（16例），三级并发症发生率分别为10．3％（3／29）、36．0％（9／25）和68．8％（11／16），三级并发症发生率两两比较差异均有统计学意义（P〈0．05）。Pearson相关性分析显示，MELD评分与CTP评分有显著相关性（r=0．874，P〈0．01）。MELD评分和CTP评分判断患者围手术期并发症的ROC曲线下面积分别为0．877（95％CI：0．84-0．95）和0．852（95％Ch0．83～0．94），两者比较差异无统计学意义（U=0．157，P〉0．05）。结论MELD评分和CTP评分均能准确预测肝硬化患者围手术期并发症，临床应用宜相互结合，以进一步提高预测准确度。

Objective To investigate the value of the model for end-stage liver disease （MELD） and Child-Turcotte-Pugh （CTP） score in predicting the prognosis of patients with liver cirrhosis. Methods Seventy patients with liver cirrhosis were selected. The MELD and CTP score before surgery was calculated and was analyzed the correlation between the two models was analyzed. The prognosis ability by the area under the receiver operating characteristic （ROC） curve was evaluated. Results Twenty three cases （32.9%, 23/70） appeared post operative serious complication. The scores of MELD and CTP in complication group （23 cases） was （19.58 ±5.90）, （8.84 ± 1.87） scores, the scores of MELD and CTP in without complication group （47 cases） was （ 12.27 ± 2.94）, （6.10 ± 1.12） scores, there were significant differences between two groups （P 〈 0.01）. According to the MELD score,70 patients was divided into 〈 14 scores group（30 cases）, 14 - 23 scores group（28 cases）, 〉 23 scores group（ 12 cases） ,the rate of complication was 10.0%（3/30）, 35.7%（10/28） and 83.3%（10/12） ,there were significant differences among three groups（P〈 0.05 ）. According to the CTP score, 70 patients were divided into A grade （29 cases）, B grade （25 cases） and C grade（ 16 cases ）, the rate of complication was 10.3%（3/29）, 36.0% （9/25） and 68.8% （11/16）, there were significant differences among three groups （P 〈 0.05 ）. The results of Pearson correlation analysis showed that the MELD score and CTP score had significant correlation （r = 0.874,P 〈 0.01 ）. The area under the ROC curve of the MELD score and CTP score in prognosis the perioperative complication was 0.877 （95% CI： 0.84 - 0.95 ） and 0.852 （95% CI： 0.83 - 0.94）, there was no significant difference （U = 0.157,P 〉 0.05）. Conclusion Both MELD and CTP score can accurately predict the short term prognosis of patients with liver cirrhosis.