MESO指数、MELD-Na对失代偿期肝硬化短期预后的价值对比

目的评价终末期肝病模型（MELD）评分、MELD-Na模型评分、MESO指数对失代偿期肝硬化短期预后的预测价值。方法分别计算115例失代偿期肝硬化患者的MELD、MELD-Na、MESO指数分值,运用ROC曲线及曲线下面积（AUC）比较三种评分系统判断失代偿期肝硬化患者短期预后的准确性。结果115例患者随访3个月内34例死亡。死亡组MELD、MELD-Na、MESO指数均高于生存组（P〈0．05）,在判断患者3个月生存时间的ROC曲线AUC比较中,MESO指数〉MELD-Na〉MELD（P〈0．05）。结论MELD、MELD-Na、MESO指数均可有效地预测失代偿期肝硬化患者的短期预后,而MESO指数对短期预后评估效率优于MELD-Na．能更准确反映病情严重程度及预后。     

四种评分系统对失代偿期肝硬化患者短期预后的评价

目的比较终末期肝病模型(MELD))评分系统、MELD-Na评分系统、MESO指数评分系统以及iMELD评分系统对失代偿期肝硬化患者短期(3个月)预后的预测价值。方法选择2008年10月至2011年10月云南省第三人民医院消化内科的失代偿期肝硬化患者230例,分别计算每例患者入院时的MELD、MELD-Na、MESO及iMELD分值,采用Kaplan-Meier法比较生存率,运用受试者工作特征曲线(ROC)及曲线下面积(AUC)比较四种评分系统判断失代偿期肝硬化患者短期预后的价值。结果 230例失代偿期肝硬化患者,随访3个月内死亡68例,生存组MELD、MELD-Na、MESO及iMELD评分分别为22.34±4.36、24.26±5.45、1.62±0.23和37.59±6.97,死亡组MELD、MELD-Na、MESO及iMELD评分分别为27.76±5.28、30.11±6.19、2.05±0.1 8和46.65±7.01。死亡组与生存组的MELD、MELD)-Na、MESO及iMELD评分比较,差异均有统计学意义(P=0.005,0.005,0.000,0.003)。MELD、MELDNa、MESO及iMELD评分系统在判断230例失代偿期肝硬化患者3个月生存时间的ROC曲线下面积分别为0.852、0.856、0.857和0.847,95%可信区间分别为0.759～0.897、0.754～0.893、0.760～0.898、0.781～0.906,四种评分系统比较差异无统计学意义(P>0).05)。结论 MELD、MELD-Na、MESO及iMELD评分系统对失代偿期肝硬化患者短期预后均有一定的预测价值,但四种评分系统比较差异无统计学意义,较准确的预后判断仍需要结合临床实际。     

终末期肝病模型对肝硬化失代偿期患者预后的预测价值

目的评估终末期肝病模型（MELD）、终末期肝病模型联合Na评分（MELD-Na）、终末期肝病模型评分／血钠比值（MESO指数）、Child-Pugh（CTP）分值对失代偿期肝硬化患者预后的预测价值。方法对140例失代偿期肝硬化患者进行回顾性分析。分别比较3、6及12个月内死亡组和存活组之间的MELD评分、MELD-Na评分、MESO指数及CTP分值,并用受试者工作曲线（ROC）及曲线下面积（AUC）比较MELD、MELD—Na评分、MESO指数和CTP分值判断肝硬化患者预后的准确性并获取最佳临界值。结果在随访的3、6及12个月内死亡组和存活组MELD、MELD—Na、MESO及CTP评分比较有显著差异,在判断患者3、6及12个月生存率的ROC曲线Auc比较中,MELD—Na评分与MESO指数、MELD评分及CTP分值比较具有统计学意义差异（P〈O．05）。而MELD评分与Child-Pugh分值比较差异无统计学意义（P〉0．05）。结论MELD—Na评分、MESO、MELD及CTP均能较好预测肝硬化失代偿期患者预后,其中MELD—Na仍是以上预测失代偿期肝硬化预后中最具优势的评分模型。     

应用MELD-Na模型评估失代偿期肝硬化患者的短期预后

目的评估终末期肝病血清钠(MELD-Na)、终末期肝病模型(MELD)及Child-Pugh评分系统对失代偿期肝硬化患者短期预后的预测价值。方法对具有完整记录和随访结果的96例失代偿期肝硬化患者的资料进行分析,分别计算每例患者的Chlid-Pugh、MELD及MELD-Na分值,使用受试者工作曲线(ROC)及曲线下面积(AUC)比较3种评分系统判断失代偿期肝硬化患者生存3个月的准确性。结果 96例患者3个月内有25例患者死亡。死亡组的Child-Pugh、MELD及MELD-Na评分均高于生存组(P0.01);MELD-Na和MELD评分在判断患者3个月生存时间的ROC曲线AUC均大于Child-Pugh(P0.001,P0.01),MELD-Na和MELD评分AUC差异均无统计学意义(P0.05)。结论 MELD-Na是判断失代偿期肝硬化患者短期预后的一个较好指标,其准确性优于Child-Pugh分级,但与MELD评分相比无明显差异。     

Logistic预测模型对失代偿期肝硬化预后的临床价值研究

目的评价Logistic模型及3个传统肝硬化预后模型(MELD模型、MELD-Na模型及CTP评分)对失代偿期肝硬化患者3个月及1年预后的预测价值。方法回顾性分析南昌大学第一附属医院消化科2003年1月至2008年12月期间住院且病历资料及随访结果完整的失代偿期肝硬化1086例,记录1086例患者入院第1天的MELD-Na、MELD、CTP积分,随访患者在3个月及12个月内生存情况。通过Logistic单因素及多因素回归分析,得出对失代偿期肝硬化患者3个月内预后有影响的因素,并建立Logistic模型;应用ROC及其AUC比较Logistic模型、MELD-Na、MELD、CTP评分预测肝硬化患者预后的准确性。结果4种模型对失代偿期肝硬化患者3个月及1年内预后预测均有较好价值。Logistic模型在预测失代偿期肝硬化患者3个月预后方面优于MELD模型及CTP(P<0.05),与MELD-Na模型对比差异无统计学意义(P>0.05),但AUC大于MELD-Na模型;Logistic模型在预测失代偿期肝硬化患者1年预后方面优于CTP(P<0.05),与MELD-Na及MELD模型对比无统计学差异,但AUC大于MELD-Na及MELD模型。结论4种模型均能较好地预测失代偿期肝硬化3个月及1年预后情况,Logistic模型、MELD-Na模型优于CTP,其中Logistic模型预测该类患者预后的AUC最大。     

终末期肝病模型评分/血钠比值对肝硬化食管静脉曲张破裂出血硬化治疗预后判断的价值

目的评估终末期肝病模型评分/血钠比值(MESO指数)对肝硬化食管静脉曲张破裂出血(esophageal varices rupture and bleeding,EVB)患者内镜硬化治疗(endoscopic sclerotherapy,EIS)的生存预测价值。方法回顾性分析41例具有完整随访资料、且首次发生EVB并行急诊EIS的肝硬化患者,分别计算每例患者入院当天的血钠比值(blood sodium ratio,MESO)指数、MELD-Na、终末期肝脏病模型(end-stage liver disease model,MELD)和Child-Turcotte-Pugh(CTP)评分值。分析MESO指数与MELD-Na、MELD、CTP评分的相关性。以受试者工作曲线(ROC)及曲线下面积(AUC)评价上述各模型判断行急诊EIS患者预后的准确性。获取各模型判断患者预后死亡风险的最佳临界值。结果随访3个月、12个月,生存患者与死亡患者年龄、性别构成比较差异无统计学意义(P0.05)。41例患者随访3个月有5例死亡,死亡组MESO指数1.34±0.10,生存组0.49±0.11;随访1年死亡患者12例,生存组MESO指数0.36±0.14,死亡组1.26±0.15,差异具有统计学意义(P0.05)。MESO指数、MELD、MELD-Na和CTP评分对3个月预后评估的ROC曲线下面积分别为0.917、0.857、0.854和0.786,对1年预后评估的ROC曲线下面积分别为0.885、0.835、0.829和0.746,但差异无统计学意义(P0.05)。MESO指数的最佳临界值有较高的死亡风险判断价值。判断患者预后时,ROC曲线下面积值0.800的模型,3个月为MESO(0.917)、MELD(0.857)、MELD-Na(0.854);12个月为MESO(0.885)、MELD(0.835)、MELD-Na(0.829)。结论 MESO指数越高,死亡风险越大,MESO指数对肝硬化EVB患者行急诊EIS的3个月和1年预后的判断有较高的准确性。     

MELD-Na模型评分对评估失代偿期肝硬化患者短期预后的临床价值

目的 评价终末期肝病模型（MELD）评分、Child-Pugh（CTP）计分及MELD-Na模型评分（MELD-Na^＋）对失代偿期肝硬化患者短期预后的预测价值。方法 分别计算116例失代偿期肝硬化患者的MELD、Child-Pugh及MELD-Na分值,运用ROC曲线及曲线下面积（AUC）比较三种评分系统判断失代偿期肝硬化患者短期预后的准确性。结果 116例患者随访3个月内有34例患者死亡,死亡组MELD-Na评分（24．1±2．5）与生存组（15．4±2．9）比较差异有统计学意义（P〈0．001）;在判断患者预后的ROC曲线AUC比较中,MELD-Na评分（0．825）〉MELD评分（0．779）〉Child-Pugh分级（0．626,P〈0．05）。结论 Child-Pugh计分、MELD计分和MELD-Na计分均可有效地预测失代偿期肝硬化患者的短期预后,而MELD-Na模型评分对短期评估效率优于其他两种方法,能更准确地反映病情的轻重,更具有临床应用价值。     

三种评分方法预测肝硬化并食管静脉曲张破裂再出血风险的价值比较

目的 比较终末期肝病模型(MELD)、MELD-Na及Child-Pugh评分对失代偿期肝硬化并食管静脉曲张破裂出血患者3个月及1年内再出血风险的预测价值.方法 回顾性分析2003年1月至2008年10月收治的病历资料失代偿期肝硬化并食管静脉曲张破裂出血患者365例并随访1年.将患者分为低钠血症组与血钠正常组,记录每例患者入院第1天的MELD-Na、MELD、Child-Pugh评分,随访患者在3及12个月内的再出血情况,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC),比较MELD-Na、MELD、Child-Pugh评分三者预测再出血风险的准确率,并应用正态Z检验对三者曲线下面积进行比较.结果 MELD-Na和MELD预测患者3个月内再出血风险的AUC分别为0.825和0.779,预测1年内再出血风险的AUC则分别为0.842和0.802,均高于Child-Pugh评分(0.678和0.634,P值均＜0.05),但MELD-Na和MELD间差异无统计学意义(P＞0.05).结论 MELD-Na及MELD均能预测失代偿期肝硬化并食管静脉曲张破裂出血患者再出血风险,且均优于Child-Pugh评分.MELD-Na弥补了MELD的部分不足.     

血钙水平联合胆碱酯酶、MELD-Na评分对肝硬化失代偿患者预后评估的临床价值

背景:肝硬化失代偿为消化内科常见病且患者预后差,目前肝硬化相关评分模型非常多,但均有一定的局限性。目的:探究血钙水平联合胆碱酯酶、MELD-Na评分对肝硬化失代偿患者预后评估的临床价值。方法:选取2017年1月—2020年12月温州医科大学附属衢州医院收治的肝硬化终末期住院患者169例,检测血钙水平、胆碱酯酶、肌酐、国际标准化比值(INR)、凝血酶原时间、总胆红素(TBIL)、血钠水平等,计算MELD评分和MELD-Na评分。采用ROC曲线分析各个指标评估肝硬化失代偿患者预后的价值。结果:随访6个月后,125例患者存活,44例死亡。存活组TBIL、肌酐、INR、凝血酶原时间、MELD评分、MELD-Na评分显著低于死亡组(P0.05),白蛋白、血钠水平、血钙水平、胆碱酯酶显著高于死亡组(P0.05)。ROC曲线示血钙水平、胆碱酯酶、MELD评分、MELD-Na评分评估肝硬化失代偿患者预后的AUC分别为0.824、0.783、0.781和0.839。联合血钙水平、胆碱酯酶和MELD-Na评分预测肝硬化失代偿患者短期预后的AUC升至0.897。结论:血钙水平、胆碱酯酶、MELD-Na评分三者联合对肝硬化失代偿患者6个月预后的评估有较高的预测价值。     

MELD-Na模型预测失代偿期肝硬化患者短期预后价值的评估

目的比较MELD-Na模型、MELD模型和Child-Pugh积分对我国失代偿期肝硬化患者短期预后的预测价值。方法回顾性收集自2003年1月～2005年12月在天津第三中心医院住院的206例失代偿期肝硬化患者的病历资料。分别计算其入院时的MELD-Na积分、MELD积分和Child-Pugh积分,同时了解其3个月内的病死率。以受试者运行曲线(receiver operating characteristic,ROC)下面积(area under the curve,AUC)衡量各评分系统预测失代偿期肝硬化患者短期预后的能力。结果所观察的患者在3个月内共死亡39例。死亡组患者MELD-Na积分、MELD积分和Child-Pugh积分(9.26±12.03、21.49±6.75、11.18±1.76)与生存组(18.65±9.69、15.83±4.99、9.16±2.19)相比有显著性差异(P<0.001)。MELD-Na积分、MELD积分和Child-Pugh积分对失代偿期肝硬化患者3个月预后评估的ROC曲线下面积分别为0.777、0.760、0.759;运用正态性Z检验比较其各自的AUC,MELD-Na模型分别与MELD模型和Child-Pugh评分相比均有显著性差异(P<0.001),而MELD模型和Child-Pugh评分相比无差异(P=0.80)。通过选取敏感性和特异性之和最大时ROC曲线上的截断点对应的值作为将肝硬化患者区分高、低危组群的方法,确定MELD-Na模型、MELD模型和Child-Pugh评分所对应的cut-off值分别为23、18和10,以此临界点所区分的高危和低危患者的生存率之间均存在明显差异(P<0.001)。结论 MELD-Na积分、MELD积分和Child-Pugh积分均可有效地预测失代偿期肝硬化患者的短期预后,而MELD-Na评分的短期评估效率优于其他3种,能更准确地反映病情的轻重,临床应用价值更高。     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.