天津医药

• 临床研究 • 上一篇    下一篇

终末期肝病评分模型在评价慢性肝衰竭人工肝治疗效果中的应用

宋立文1,李谦1,刘欢1,李菲1,曹武奎2,杨积明1   

  1. 1. 天津市第二人民医院，天津市肝病医学研究所
    2. 天津市传染病医院
  • 收稿日期:2013-11-29 修回日期:2014-01-23 出版日期:2014-05-15 发布日期:2014-05-15
  • 通讯作者: 杨积明

End-stage Liver Disease Score Model in The Evaluation of Chronic Liver Failure Application Effect of Artificial Liver Treatment

  • Received:2013-11-29 Revised:2014-01-23 Published:2014-05-15 Online:2014-05-15

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摘要： 目的 比较终末期肝病模型（MELD）、MELD-Na 模型、iMELD模型评分系统对预测慢性肝功能衰竭患者短期预后的价值。方法 选取159例慢性肝衰竭患者，分为存活组（108 例）和死亡组（51 例），测量并比较2组的总胆红素（TBIL）、血清肌酐（Cr）、凝血酶原时间（PT）、PT 的国际标准化比率（INR）、血清钠(Na+)、MELD、MELD-Na 和iMELD评分值。应用受试者工作特征（ROC）曲线下面积评价MELD、MELD-Na 及iMELD评分对慢性肝衰竭短期预后的预测价值。结果 死亡组的年龄、TBIL、Cr、Na+、INR、MELD、MELD-Na 及iMELD 评分高于存活组，血清Na+水平低于存活组，差异有统计学意义（P < 0.01）。MELD、MELD-Na 和iMELD评分越高，病死率越高。MELD、MELD-Na 及iMELD 评分所得最佳临界值分别为25.8、31.0 和53.5。MELD评分的曲线下面积（AUC）与MELD-Na 评分（Z=0.041，p >0.05）和iMELD 评分（Z=0.700，p >0.05）无统计学差异，MELD-Na 评分的AUC与iMELD 评分（Z=0.655，p>0.05）无统计学差异。结论 MELD、MELD-Na 和iMELD评分均能较好地预测肝衰竭患者经过人工肝联合内科综合治疗后短期临床预后。

关键词: 肝功能衰竭, 终末期肝病模型, MELD-Na模型肝衰竭评估, 预后

Abstract: Objective： To investigate the value of model for end -stage liver disease (MELD) score, MELD with incorporation of serum sodium (MELD-Na) score and integrated MELD (iMELD) score for evaluation of prognosis of chronic liver failure. Methods ：A total of 159 consecutive patients with chronic liver failure were included in the study and divided into two groups (death group and survival group) according to the prognosis. The levels of total bilirubin (TBIL), serum creatinine (Cr), prothrombin time (PT), PT international normalized ratio (INR), Serum sodium (Na), age, MELD, MELD-Na and iMELD were calculated respectively and the comparative analysis was performed. Areas under the receiver operating characteristic curve (AUC-ROC) of MELD, MELD-Na and iMELD were used to assess the prognosis in patients with chronic liver failure. Results: The values of TBIL, INR, MELD, MELD-Na and iMELD were significantly higher in death group than those in survival group (P < 0.01). The serum level of Na+ was significantly lower in death group than that of survival group (P < 0.01). The mortality of liver failure was higher in patients with the increased scores of MELD, MELD-Na and iMELD. The area under curve (AUC) values generated by the ROC curves was no difference respectively (P > 0.05) for MELD score (AUC=0.691), MELD-Na score (AUC=0.690) and iMELD score (AUC=0.674) . The cut-off scores of three systems were 25.8 (MELD), 31.0 (MELD-Na) and 53.5 (iMELD) respectively, which could discriminate higher and lower mortality accurately. Conclusion: MELD, MELD-Na and iMELD score can predict liver failure patients undergoing artificial liver comprehensive medical treatment combined short-term clinical outcomes.

Key words: Liver failure, model of end-stage liver disease, MELD-Na model assessment of liver failure, prognosis