终末期肝病模型预测慢性乙型重型肝炎预后的评估

Prognostic value of the model for end-stage liver disease score for patients with severe chronic hepatitis B

目的分析终末期肝病模型(model for end-stage liver disease,MELD)评估我国慢性乙型重型肝炎患者预后的临床价值。方法回顾性分析2006年1月至2008年12月5家医院收治的慢性乙型重型肝炎住院患者561例临床资料,分为生存组和死亡组,计算患者入院时的MELD评分,应用t’检验、Logistic回归分析、受试者工作特征(receiver operating characteristic curve,ROC)曲线下面积(area under curve,AUC)评价MELD对慢性乙型重型肝炎预后的预测价值。结果生存组的MELD分值为(22.25±4.35),死亡组MELD分值为(28.94±8.76),差异有统计学意义(P<0.01)。Logistic回归分析表明,在其他影响因素均衡的条件下,MELD分值每增加1,死亡的可能性增加至1.182倍,MELD评分的Logistic回归方程预测预后总的正确率为68.4%,且差异有统计学意义(P<0.01);MELD评分的AUC为0.759,95%置信区间为(0.720～0.798),MELD界值为27,其诊断的正确度为中等。结论 MELD评分系统预测我国慢性乙型重型肝炎患者的预后有临床应用价值,但效能中等。

Objective To tnyestigate the validity of the model for end-stage liver disease(MELD)score in predicting the prognosis of patients with severe chronic hepatitis B(CHB).Methods A total of 561 patients with severe CHB collected from January 2006 to December 2008 tn 5 hospitals were divided into the survivor group and the death group.MELD score of all the cases was calculated and its predictive value for severe CHB was evaluated by i-test,logistic regression analysis and the area under the receiver operating characteristic curve(AUROC).Results The average MELD score tn the death group was statistically higher than that tn the survivor group(28.94土8.76 vs.22.25土4.35,P<0.001).The mortality would be increased to 1.182 tmes every 1 score increased m MELD.The predictive accuracy rate of MELD score using logistic regression analysis was 68.4%(P<0.001).AUROC for prediction of the mortality in patients using MELD score was 0.759 with medium accuracy(95%confidence interval:0.720-0.798,MELD threshold:27).Conclusion MELD score may be useful tn predicting the prognosis of patients with severe CHB,but the power is medium.Therefore,a better mathematical model should be developed to predict the prognosis of the patients with severe CHB in China.