Child-Turcotte-Pugh评分差值对肝硬化患者短期预后的预测价值

Predictive value of Child-Turcotte-Pugh score difference in short-term prognosis of patients with liver cirrhosis

目的评估Child-Turcotte-Pugh(CTP)评分近期变化对肝硬化患者短期预后(5个月)的预测价值。方法选择228例肝硬化患者,计算患者入院时和入院1个月后的CTP评分,以及终末期肝病评估模型(MELD)评分,两次CTP评分的差值即△CTP评分。通过Kaplan-Meier生存分析,计算不同CTP、△CTP、MELD评分的患者的5个月生存率。通过受试者工作特征(ROC)曲线下面积(AUC),比较CTP、△CTP、MELD评分预测肝硬化患者5个月生存率的准确性。结果对CTP、△CTP、MELD评分各组之间进行生存分析对比,CTPA级组与B级组、MELD<10组与10≤MELD<20组生存曲线之间的差异无统计学意义,其余各组5个月生存曲线之间的差异均有统计学意义(P<0.05)。绘制ROC曲线,CTP、△CTP、MELD评分的AUC分别为0.884、0.938、0.827,△CTP评分的AUC最大,提示其预测的准确性最高。结论△CTP评分是预测肝硬化患者短期预后的有效指标,其预测准确性高于CTP和MELD评分,可作为肝硬化患者预后的有效预测指标之一。

Objective An attempt was made in this paper to evaluate the predictive value of recent changes in the Child-Turcotte-Pugh (CTP) score for short-term prognosis (5 months) in patients with cirrhosis. Methods Two hundred and twenty-eight patients with cirrhosis were enrolled, and the CTP scores at the time of admission and 1 month after admission, as well as the model for end-stage liver disease (MELD) score, were calculated. The difference between the two CTP scores was ΔCTP score. The 5-month survival rate of patients with different CTP,ΔCTP, and MELD scores was calculated by Kaplan-Meier survival analysis. The accuracy of the 5-month survival rate in patients with cirrhosis was compared by CTP,△CTP, and MELD score by the area under the receiver operating characteristic (ROC) curve (AUC). Results The survival analysis of the CTP,△CTP, and MELD score group showed no significant difference in survival curves between CTP A group and CTP B group, MELD<10 group and 10≤MELD<20 group. The differences between the 5 months survival curves of the other groups were statistically significant ( P <0.05). The ROC curve was drawn, in which the AUC of CTP,△CTP and MELD score were 0.884, 0.938 and 0.827 , respectively. Besides, the AUC of △CTP score was the largest, suggesting that the diagnostic accuracy was the highest. Conclusion △CTP score is an effective predictor of short-term prognosis in patients with liver cirrhosis, whose prediction accuracy is higher than that of CTP and MELD score, which can be used as one of the effective predictor in prognosis of patients with liver cirrhosis.