MELD分级与Child分级对328例肝硬化患者临床评估的比较

目的比较MELD和Child分级评估差异,分析影响预后的危险因素。方法回顾328例肝硬化患者2.5年,计算入院当天MELD和Child分值,通过ROC曲线及截断值比较分析,利用Spearman等级相关检验研究两体系相关性。结果3个月生存期的患者两体系ROC曲线面积有显著差异(P<0.05),而生存期超过1年的患者MELD较Child分级无明显差异(P>0.05)。短期内MELD>13,敏感性为74.7%,特异性97.8%;胆红素>2.8 mg/dl,敏感性为53.7%,特异性93.5%;INR>1.53,敏感性为48.8%,特异性93.9%;有腹水,敏感性为67.1%,特异性58.9%。两体系显著相关(r=0.785,P<0.01)。结论MELD和Child均精确评估各生存期预后;MELD适宜评估急、危重患者,预后超过1年的患者无明显优势。MELD>13,胆红素>2.8 mg/dl,INR>1.53及有腹水均提示应尽快治疗以提高患者短期预后。

Efficacy comparison between model for end - stage liver disease grading systems and Child system in evaluations of patients with hepatic cirrhosis

Objective To assess the different utility of model for end-stage liver disease (MELD) grading systems and Child system,analyze risk factors as predictors of different survival term. Methods Three hundred and twenty-eight hepatic cirrhosis patients retrospectively within 2.5 years,were computed MELD and Child values of the admission day, compared different utility of the two methods by ROC curve and cut-off values, and studied their relationship by Spearman rank correlation method. Results In 3 months the ROC curve area of MELD was significantly different from the one of Child (P<0.05);However, in 1 year or 2 years, its difference was insignificant (P>0.05). Their correlation was conspicuous (r=0.785,P<(0.01)). Conclusion Both MELD and Child can accurately evaluate the prognosis of hepatic cirrhosis patients in different term. MELD is good at evaluating severe and emergent patients, however, for evaluating the patients whose survival time is more than 1 year, MELD has no significant advantages over Child. Those factors about MELD>13,T-BL>2.8 mg/dl, INR>1.53 and ascites indicate should adopt specific treatments as soon as possible.