MELD评分预测急性毒蕈中毒患者短期临床预后

MELD score predicting short-term clinical prognosis in patients with acute mushroom poisoning

目的探讨终末期肝病模型(MELD)评分对预测急性毒蕈中毒所致肝功能损害患者短期预后的临床价值。方法将我院感染消化科2014年7月~2017年9月收治的20例急性毒蕈中毒患者纳入研究,按照出院时生存与否分为生存组与死亡组,比较两组患者的相关观察指标。结果 12例生存,8例病情恶化死亡。两组的ALT、AST、TBil、Alb、SCr、WBC差异无统计学意义(P>0.05),两组的MELD和凝血酶原活动度(PTA)差异有统计学意义(P=0.001,P=0.047)。以MELD绘制其判断患者短期预后的ROC曲线,曲线下面积为0.927。以MELD<14.57分作为预测毒蕈中毒患者预后良好的临界阈值,其灵敏度为100%,特异度为75%。结论 MELD评分可以有效预测急性毒蕈中毒所致肝功能损害患者的短期预后。

Objective To investigate the clinical value of model for end-stage liver disease(MELD)score predicting short-term prognosis in patients with acute mushroom poisoning which leads to liver function damage.Methods From July 2014 to September 2017,20 cases with acute mushroom poisoning admitted into infection and digestive department in our hospital were enrolled the study.According to whether there was survival or death at discharge,they were divided into the survival group and death group.The differences of clinical manifestation and experimental examinations were compared.Results There were 12 patients were survival and 8 patients dead due to deterioration of the condition.There was no great difference in alanine transaminase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),albumin(Alb),creatinine(SCr),and white blood cell(WBC).MELD and prothrombin time activity(PTA)were displayed statistical differences(P=0.001,P=0.047).The receiver operating characteristic(ROC)curve was drawn with MELD to determine the short-term prognosis,and the area under the curve was 0.927.MELD<14.57 points was selected as a predictor of mushroom poisoning threshold of patients with good prognosis,and the sensitivity and specificity was 100%and 75%respectively.Conclusion MELD score can effectively predict the short-term prognosis in patients with liver function damage caused by acute mushroom poisoning.