MELD与改良MELD在评价慢性重型肝炎预后中的应用与比较

A comparative study of five prognostic systems for predicting the prognosis of patients with chronic severe hepatitis

目的比较终末期肝病模型(MELD)及改良MELD评分系统预测慢性重型肝炎患者预后的价值。方法回顾性分析76例慢性重型肝炎患者的临床资料,计算患者入院时的MELD评分、MESO指数、MELD-Na、iMELD和uMELD评分值,所有患者随访3月,绘制受试者工作特征曲线并计算曲线下面积(AUC),应用正态Z检验对曲线下面积进行比较。结果 76例慢性重型肝炎随访3月后死亡56例,生存20例,死亡组患者MELD评分、MESO指数、MELD-Na、iMELD和uMELD评分值均高于生存组,差异具有统计学意义(P<0.01)。各评分系统的AUC分别为0.786、0.788、0.749、0.862、0.768,差异无统计学意义。结论 MELD评分、MESO指数、MELD-Na、iMELD和uMELD评分对评价慢性重型肝炎预后均有较好的价值。

Objective To compare the predictive values of five prognostic system including model for end stage liver disease（MELD）,MELD-Na,MESO,integrated MELD（iMELD）,updated MELD（uMELD） in predicting the prognosis of patients with chronic severe hepatitis. Methods 76 patients with chronic severe hepatitis were retrospectively studied and followed-up for 3 months.MELD,MELD-Na,MESO,iMELD and uMELD scores were caculated at the day of admission. Area under the curve（AUC） was calculated and compared by Z-test. Results Of 76 patients,there were56 cases dead and 20 survived. The scores in dead group evaluated by MELD,MELD-Na,MESO,iMELD and uMELD scoring systems were higher than those in survival group（P〈0. 01）. The values of AUC of these five system were 0. 786,0. 788,0. 749,0. 862 and 0. 768 respectively. Conclusion MELD,MELD-Na,MESO,iMELD and uMELD are all useful prognostic indicator for patients with chronic severe hepatitis.