终末期肝病模型联合血清钠评估肝硬化失代偿期患者的预后价值

目的 评价终末期肝病模型(MELD)联合血清钠模型(MELD-Na、MELDNa、MESO评分)在判断肝硬化失代偿期患者6、12个月预后方面的价值.方法 选择具有完整临床资料和随访结果的119例肝硬化患者进行回顾性分析,分别应用MELD、MELD-Na、MELDNa、MESO评分模型进行评分,并了解其6、12个月内的病死率,运用受试者工作特征(ROC)曲线下面积衡量各评分系统预测肝硬化失代偿期患者6、12个月预后的能力,并采用Z检验比较各系统的预测能力.结果 随访6、12个月中,生存和死亡患者间MELD、MELD-Na、MELDNa、MESO评分比较差异均有统计学意义.MELD-Na、MELDNa、MESO评分在判断患者6、12个月的预后方面其ROC曲线下面积均大于0.8,在数值上优于MELD评分,但差异无统计学意义.结论 MELD联合血清钠模型在判断肝硬化失代偿期患者6、12个月预后方面具有良好的准确性,但未显示比MELD评分有更佳的预测能力.

Value of model for end-stage liver disease combined with serum sodium in predicting the prognosis of cirrhosis

Objective To evaluate the capability of model for end-stage liver disease (MELD)combined with serum sodium (MELD- Na,MELDNa and MESO scores) in predicting the prognosis of patients with decompensated liver cirrhosis in 6 and 12 months.Methods One hundred and nineteen patients with decompensated liver cirrhosis and completed follow-up data were retrospectively studied.The MELD,MELD- Na,MELDNa and MESO scores were calculated according to the clinical data of each patient.Receiver operating characteristic (ROC) curve and the area under the curve (AUC) was used to measure the values of the four models in predicting the 6 and 12 months survival,and Z-test was used to compare their predictive values.Results MELD,MELD-Na,MELDNa and MESO scores were significantly different between patients who survived and those who died within 6 and 12 months follow-up.The AUC for the MELD- Na,MELDNa and MESO scores were all more than 0.8 in predicting 6 and 12 months survival.However the differences of the AUC between the MELD score and MELD-Na,MELDNa,MESO scores were not significant in predicting 6 and 12 months survival.Conclusion The model for MELD combined with serum sodium can accurately predict the prognosis of patients with decompensated liver cirrhosis in 6 and 12 months,while these scores are not superior to MELD score.