动态MELD评分有助于预测HBV相关慢加急性肝衰竭预后

Dynamic changes of MELD scores can predict the prognosis of HBV-related acute-on-chronic liver failure

目的探讨在判断HBV相关慢加急性肝衰竭(HBV-related acute-on-chronic liver failure,HBV-ACLF)患者预后方面,终末期肝病模型(model for end-stage liver disease,MELD)评分的动态变化是否优于基线MELD评分。方法前瞻性收集2009—2011年在我国4家医院住院治疗的HBV-ACLF患者的临床资料,包括临床表现、实验室检查及转归等,研究MELD评分动态变化与转归的关系。结果①纳入的82例90 d病死率为37.80%。死亡组患者基线MELD评分为(25.50±4.77)分,与存活组[(23.72±4.68)分]相比,差异无统计学意义(P=0.101)。但是从入组第7天开始,死亡组MELD评分逐渐升高,存活组MELD评分逐渐下降,此后各时间点2组MELD评分相比差异均有统计学意义。②低危组(基线MELD评分≤23分者)从第14天开始,存活患者MELD评分显著低于死亡患者[(16.04±4.00)分vs(29.39±12.30)分,P<0.05],高危组(基线MELD评分>23分者)从第7天开始,存活患者MELD评分显著低于死亡患者[(22.38±4.91)分vs(28.92±6.76)分,P=0.001],并且随着时间推移,差距逐渐增加。结论判断HBV-ACLF的预后应在基线MELD评分基础上,注意其动态变化,这将有助于提高预测的准确性。

Objective To determine whether the dynamic changes of the model for end-stage liver disease （MELD） scores were superior to baseline MELD scores in predicting the prognosis of HBV-related acute-on-chronic liver failure （HBV-ACLF）. Methods A prospective study was made on HBV-ACLF patients hospitalized in four hospitals in China from 2009 to 2011. The clinical data including clinical manifestations, laboratory findings and the prognosis were observed, and the relationship between the dynamic changes of MELD scores and the prognosis was analyzed. Results The 90-day mortality rate of the enrolled 82 HBV-ACLF patients was 37.80%. The average baseline MELD scores in the non-survivor group and the survivor group were 25.50＆#177;4.77 and 23.72＆#177; 4.68, respectively, and the difference between the two groups was not significant （P=0.101）. The MELD scores gradually increased in the non-survivor group, and decreased in the survivor group from the 7th day of enrollment. The differences were significant between the two groups at the following time-points. MELD scores of the survivors were significantly less than those of the non-survivors in the low-risk group （with the baseline MELD scores less than or equal to 23） from the 14th day of enrollment （16.04＆#177;4.00 vs 29.39＆#177; 12.30, P＆lt;0.05）, and MELD scores of the survivors were significantly less than those of the non-survivors in the high-risk group （with the baseline MELD scores more than 23） from the 7th day of enrollment （22.38＆#177;4.91 vs 28.92＆#177;6.76, P=0.001）. The variations became greater as time went on. Conclusion Dynamic changes of MELD scores should be considered additionally in predicting the prognosis of HBV-ACLF besides baseline MELD scores, which will help improve the accuracy of predicting the prognosis.