慢性肝衰竭患者人工肝治疗前后的终末期肝病模型评价

目的 通过观察终末期肝病模型(MEID)在慢性肝衰竭患者人工肝治疗前后的变化,探讨其在判断预后以及人工肝治疗时机选择过程中的指导意义.方法 将75例慢性肝衰竭患者分为人工肝治疗组37例和对照组38例,应用MELD评分系统对每个患者进行评分,比较两组患者治疗前后的临床生化指标和病死率,探讨与MELD评分的关系.结果(1)人工肝组经治疗后患者血清总胆红素(TBil)、肌酐(Cr)和凝血酶原时间(PT)的国际标准化比率(LNR)、MELD分值显著降低,与对照组相比,差异有统计学意义(P<0.05).(2)人工肝组经治疗后总病死率较对照组明显下降,差异有统计学意义(P<0.05),其中MEID分值在20～29的患者,其病死率为39.1%,明显低于对照组的81.8%,差异有统计学意义(P<0.05);而MELD分值≥30者,其病死率为57.1%,与对照组的93.8%相比,差异有统计学意义(P<0.05).(3)△病死率MELD分值在20～29组(42.7%)明显高于MELD≥30组(36.7%),差异有统计学意义(P<0.05).结论 人工肝支持治疗可显著降低慢性肝衰竭患者的TBil、Cr、INR和MELD评分,改善肝功能.在改善患者预后方面,MELD分值在20～29组明显优于MELD≥30组,因而早期施行人工肝治疗效果更为理想.

Evaluation of the end-stage liver disease model in patients treated with plasma exchange

Objective To observe the changes of model for end-stage liver disease(MELD)in patients treated with artificial liver support system(ALSS)and explore its instructive effects on the prognosis and selection of ALSS.Methods 37 patients in treatment group and 38 patients in control group were included in this study.The biochemical data and MELD score of each patient were monitored.The mortality and its correspondence with the MELD score were analyzed.Results The levels of TBil and creatinine(Cr)in serum and the international normalized ratio of coagulation time(INR)together with the MELD score in patients by ALSS were markedly decrease,with a significant difference between the two groups(P <0.05).The case fatality rate was markedly reduced in treatment group compared with the control group(P < 0.05).Moreover,the case fatality rate in treatment group with MELD score between 20-29 and ≥30was remarkably lower than that in control group(39.1% :81.8%,57.1% :93.8%)(P<0.05).In addition,patients with MELD score between 20-29 possessed a high △case fatality rate compared to those with MELD score ≥30(42.7% :36.7%,P < 0.05).Conclutsions Our data demonstrate that ALSS has beneficial effects on chronic hepatic failure with a reduction in the contents of TBil,Cr,INR and MELD score,and that patients with MELD score between 20-29 possess preferable curative effects.Patients with MELD score between 20-29 should receive ALSS as soon as possible.