肝衰竭分期联合MELD评分对肝衰竭短期预后判断的研究

Liver failure staging and MELD predicted the short term prognosis of HBV-acute-on-chronic liver failure

目的探讨肝衰竭分期联合MELD评分对乙型肝炎病毒(HBV)相关慢加急性肝衰竭(HBV-ACLF)短期预后判断的临床意义。方法将该院感染消化科2013年7月至2015年7月收治的110例HBV-ACLF纳入研究,将患者分为早、中、晚期3组,比较各组3个月时的病死率。按照入组时的MELD分值,分为MELD<20分、20分≤MELD<30分、30分≤MELD<40分、40分≤MELD 4个组,比较各组3个月病死率。将肝衰竭分期为中期的患者按照△MELD(△MELD=MELD1周-MELD基线)<0分或>0分分为两组,比较两组3个月病死率。结果早(n=18)、中(n=48)、晚期(n=44)患者3个月病死率为0、50%、95%(P<0.05);MELD<20分(n=24)、20分≤MELD<30分(n=54)、30分≤MELD<40分(n=28)、40分≤MELD(n=4),各组的病死率为31.58%、66.67%、85.71%、100%(P<0.05)。肝衰竭分期为中期的患者中,按照△MELD<0分或>0分,两组的病死率分别为41.18%和85.71%(P<0.05)。结论肝衰竭早期患者生存概率大,而肝衰竭晚期以及△MELD>0的中期患者3月死亡风险高。

Objective To study the clinical significance of liver failure staging and MELD in predicting the short term prognosis of HBV-acute-on-chronic liver failure（HBV-ACLF）.Methods One hundred and ten HBV-ACLF patients admitted to our hospital from July 2013 to July 2015 were included into this study.They were divided into early stage group（n=18）,middle stage group（n=48）and end stage group（n=44）,the fatality rate in each group was evaluated.According to the MELD score at baseline,they were divided into four groups,MELD〈20（n=24）,20≤MELD〈30（n=54）,30≤MELD〈40（n=28）,40≤MELD（n=4）.The fatality rate in each group was evaluated.In the middle stage group,they were be divided into two groups,△MELD〉0and△MELD0（△MELD=MELD1W-MELDbaseline）.The fatality rate in each group was evaluated.Results The fatality rate of the 3groups（Early,Middle and End stage group）at 3th month was 0,50%,95% respectively（P〈0.05）.The fatality rate of the 4groups（MELD〈20,20≤MELD〈30,30≤MELD〈40,40≤MELD）was 31.58%,66.67%,85.71% and 100% respectively（P〈0.05）.In the middle stage group,the fatality rate of the two groups was（△MELD〈0and △MELD〉0）41.18% and 85.71%（P=0.001）.Conclusion It can be shown that the survival probability of early stage group was high,the probability of death in end stage group and middle stage group with △MELD〉0was high.