不同评分系统评估肝癌患者行肝切除术围手术期风险的临床价值

Study on the clinical value of three different scoring systems in assessing peri-operative period risk for HCC patients undergoing hepatectomy

目的比较Child-Pugh分级、终末期肝病模型(MELD)评分、慢性肝功能障碍评分(CLD)在肝癌患者行肝切除术围手术期风险评估中的应用价值。方法回顾性分析141例肝切除术肝癌患者的临床资料,术前分别计算Child-Pugh分级、MELD评分及CLD评分,并分析3种评分与术后肝功能不全发生率的关系,对比不同肝功能恢复组的Child-Pugh、MELD、CLD评分。结果 1Child-Pugh A级与B级者的肝功能不全发生率差异无统计学意义,而MELD≤14分者与>14分者、CLD≤1.0分者与>1.0分者的发生率差异均有统计学意义(χ2=10.187、12.322,P<0.05);2肝功能恢复良好组、肝功轻度不全组的Child-Pugh评分差异无统计学意义,而肝功能恢复良好组、肝功轻度不全组、肝功能重度不全组的MELD评分及CLD评分均依次递增(P<0.05);3CLD评分、MELD评分、Child-Pugh分级的ROC-AUC依次递增(P<0.05);4在特异度95%时,CLD评分的敏感度最高,MELD评分次之,Child-Pugh分级最低(P<0.05)。结论较之于目前普遍使用的Child-Pugh分级,MELD评分、CLD评分均可较准确地预测肝切除术后肝功能不全的发生情况,但CLD评分的准确性、敏感度更高,更符合我国肝病特点。

Objective To compare the clinical value of Child-Pugh, model for end-stage liverdisease（MELD） and chronic liver dsyfunction score（CLD） in assessing peri-operative period risk for HCCpatients who underwent hepatectomy. Methods One hundred and forty- one cases with hepatocellularcarcinoma were retrospectively analyzed. Before the operation, the Child-Pugh classification, MELD score,and CLD score were calculated. Analysis of the relationship between postoperative liver dysfunction rateand the three kinds of evaluation methods were conducted. Results 1 The postoperative liverdysfunction rate of Child-Pugh class A and class B showed no significant difference, while the differencesof the rate between MELD≤14 and 〉14 as well as CLD≤ 1 and 〉1 were both significant（χ~2=10.187,12.322,P〈0.05）. 2 There was no significant difference in Child-Pugh score between liver well recoveredgroup and mildly insufficient group. MELD score and CLD score of the well recovered group, mildinsufficiency group and severe insufficiency group increased, with a significant difference（P〈0.05）. 3 TheROC- AUC of CLD score, MELD score and Child- Pugh increased in order and the difference wasstatistically significant（P〈0.05）. 4When specific degree was 95%, the sensitivity of CLD was the highest,followed by MELD, and Child-Pugh was the lowest（P〈0.05）. Conclusion Compared with Child-Pughwhich is widespreadly used currently, MELD and CLD score systems both show the ability of predictingliver dysfunction, and the accuracy and sensitivity of CLD is better than MELD.