终末期肝病评分模型在评价肝衰竭预后中的应用

目的：应用终末期肝病评分模型（MELD）评价肝衰竭患者的预后。方法：回顾性分析2004年8月至2009年12月于我院肝病中心治疗的70例肝衰竭患者的临床资料,分析MELD分值与患者经内科治疗后预后的关系。结果：本组肝衰竭患者入院时MELD分值为（13.85±2.62）,经内科综合治疗后,有效组MELD分值为（12.54±1.57）,无效组为（14.99±3.60）,两组差异有显著性意义（P〈0.001）;内科综合治疗有效组并发症的发生率为13.2%（5/38）,无效组并发症发生率为62.5%（20/32）,两组比较差异有显著性意义（P=0.000）。结论：入院时MELD分值超过（14.99±3.60）的或早期出现并发症的肝衰竭患者预后极差,应尽快准备肝移植治疗。     

一种终末期肝病的危险度评分模型

一、终末期肝病的危险度评分模型的由来 近年来，经颈静脉肝内门体分流术(Transjugular intrahepatic portosystemic shunts，TIPS)广泛用于治疗门静脉高压的并发症，如控制食管胃底曲张静脉破裂出血、预防曲张静脉再出血、治疗顽固性腹水等。但急诊TIPS术后，患者病死率很高；并发现某些因素如肝病进展程度、高胆红素血症等与患者的预后有关。于是，有些学者试图寻找一种能够准确预测TIPS术后患者的生存率的模型。     

MELD评分在终末期肝病中的应用

终末期肝病模型(MELD)是主要应用血清胆红素、国际标准化比值和血清肌酐指标来评价终末期肝病病情严重程度及预后的评分系统。其在预测终末期肝病短、中期死亡率及肝移植病例选择、移植器官的管理应用中已渐趋成熟,应用范围开始扩大到重型肝炎和原发性肝癌。部分学者针对腹水、血钠浓度等影响终末期肝病预后的因素也做了相关研究,对MELD评分系统进行了补充和完善。     

终末期肝病模型的临床应用进展

肝功能衰竭(HF)是肝脏疾病重症化的共同结局。准确评估HF的严重程度,对指导选择治疗方案尤为重要。临床上已使用30余年的Child-Turcotte-Pugh(CTP)评分法,实践证明存有不足之处。终末期肝病模型(MELD)是近年来创立的判断终末期肝病病情的一个新评分方法,此文主要就其特点和临床应用进展作一综述。     

终末期肝病模型评分与肝移植

随着肝移植技术的逐渐成熟和新型免疫抑制剂的不断问世，肝移植已成为终末期肝病患者的最佳治疗方案。在美国，每年等待肝移植的患者超过18000人，但由于肝源所限，能进行肝移植的却只有5000人。CTP(Child Turcotte Pugh)分级因其本身固有的缺陷已不适于作为肝移植的标准，因此需要制定一个公平、合理的新标准来代替CTP分级。终末期肝病模型(model for end-stage liver disease，MELD)分级是2002年2月由美国器官分配联合网络(United Network for Organ Sharing，UNOS)颁布实施的成人肝移植的新标准。本文就肝移植标准的历史变化和MELD分级的产生、特点、在肝移植方面的应用与发展及目前存在的问题作一叙述。     

终末期肝病模型评分联合血清钠预测肝硬化预后的研究

目的 探讨终末期肝病模型(MELD)联合血清钠(SNa)对肝硬化并发症及其预后的预测价值.方法 记录114例肝硬化患者入院当天MELD评分和SNa,分析其与肝硬化并发症及预后的关系.结果 低钠血症及MELD评分≥18时肝硬化患者死亡率明显增高.MELD评分联合血清钠预测住院期间死亡率敏感性76.5%,特异性86.5%.住院期间发生食管静脉曲张破裂、肝性脑病、自发性腹膜炎及肝肾综合征患者MELD评分及SNa水平与无并发症组相比均有统计学差异.结论 MELD和低钠血症联合检测有助于提高对肝硬化患者预后的预测.     

一种新的终末期肝病评分方法

肝硬化病人的预后评估一直是临床医生亟待解决的重要课题。由于肝移植技术不断提高，接受移植的人数增多，但供体数却相对缺乏，延长病人的等待时间，完善的评估体系可以改善这个矛盾，有助于为病人选择更合理的治疗方案。本文简单介绍肝功能评分体系的发展，并介绍一种新的评分体系——终末期肝病模型（model for end-stage liver disease．MELD）。     

终末期肝病模型的近期研究进展

自2000年美国Mayo Clinica的Malinchoc等[1]最初创立终末期肝病模型(MELD)评分以来,随后的研究证实其为不同的终末期肝病生存率准确的预测指标.2002年美国器官分配网络(UNOS)正式将MELD评分作为确定肝移植器官分配优先权的标准.     

终末期肝病模型在肝病中的应用进展

终末期肝病模型(modelforend-stageliverdisease,MELD)是近年来新创立的判断晚期肝病病情的方法,最初他是用于评估行经颈静脉肝内门体分流术(transjugularintrahepaticportosystemicshunt,TIPS)后患者的生存率,目前已被广泛应用于肝移植、终末期肝病患者预后、评估肝癌患者术后(手术切除癌灶或局部治疗等)生存率等方面,现认为MELD模型可以有效的预测终末期肝病患者的预后,能准确的反映病情的危急程度.     

终末期肝病评分模型评价分子吸附再循环系统治疗重型肝炎的疗效和预后

应用分子吸附再循环系统（MARS）对27例重型肝炎患者进行治疗，并用终末期肝病评分模型（MELD）评估病情严重程度，对患者MARS治疗后3个月的临床转归进行研究。     

The model for end-stage liver disease (MELD)

The Model for End-stage Liver Disease (MELD) was initially created to predict survival in patients with complications of portal hypertension undergoing elective placement of transjugular intrahepatic portosystemic shunts. The MELD which uses only objective variables was validated subsequently as an accurate predictor of survival among different populations of patients with advanced liver disease. The major use of the MELD score has been in allocation of organs for liver transplantation. However, the MELD score has also been shown to predict survival in patients with cirrhosis who have infections, variceal bleeding, as well as in patients with fulminant hepatic failure and alcoholic hepatitis. MELD may be used in selection of patients for surgery other than liver transplantation and in determining optimal treatment for patients with hepatocellular carcinoma who are not candidates for liver transplantation. Despite the many advantages of the MELD score, there are approximately 15%-20% of patients whose survival cannot be accurately predicted by the MELD score. It is possible that the addition of variables that are better determinants of liver and renal function may improve the predictive accuracy of the model. Efforts at further refinement and validation of the MELD score will continue.     

Model for end-stage liver disease (MELD) and allocation of donor livers

BACKGROUND & AIMS: A consensus has been reached that liver donor allocation should be based primarily on liver disease severity and that waiting time should not be a major determining factor. Our aim was to assess the capability of the Model for End-Stage Liver Disease (MELD) score to correctly rank potential liver recipients according to their severity of liver disease and mortality risk on the OPTN liver waiting list. METHODS: The MELD model predicts liver disease severity based on serum creatinine, serum total bilirubin, and INR and has been shown to be useful in predicting mortality in patients with compensated and decompensated cirrhosis. In this study, we prospectively applied the MELD score to estimate 3-month mortality to 3437 adult liver transplant candidates with chronic liver disease who were added to the OPTN waiting list at 2A or 2B status between November, 1999, and December, 2001. RESULTS: In this study cohort with chronic liver disease, 412 (12%) died during the 3-month follow-up period. Waiting list mortality increased directly in proportion to the listing MELD score. Patients having a MELD score <9 experienced a 1.9% mortality, whereas patients having a MELD score > or =40 had a mortality rate of 71.3%. Using the c-statistic with 3-month mortality as the end point, the area under the receiver operating characteristic (ROC) curve for the MELD score was 0.83 compared with 0.76 for the Child-Turcotte-Pugh (CTP) score (P < 0.001). CONCLUSIONS: These data suggest that the MELD score is able to accurately predict 3-month mortality among patients with chronic liver disease on the liver waiting list and can be applied for allocation of donor livers.     

The model for end-stage liver disease (MELD) predicts survival of liver cirrhosis patients after discharge to hospice

AIM: To assess if the Model for End-stage Liver Disease (MELD) score correlates with survival of liver cirrhosis patients after discharge to hospice. METHODS: Patients who were discharged to a hospice program for decompensated liver cirrhosis during a 7-year period were identified. MELD score was calculated for all patients. Medical records and the Social Security Death Index (SSDI) were used to determine the exact date of death and survival after discharge. RESULTS: Fifty patients were identified. Average MELD score was 26.4. Exact date of death was available for 42 of these patients. Average survival after discharge to hospice was 36.83 days. There was a moderate correlation (r=-0.61, P<0.0001) between MELD scores and survival after hospice discharge. The area under the receiver operating characteristic curve for MELD score predicting 30-day mortality was 0.84. MELD score >/=25 predicted 30-day mortality with a sensitivity of 74.19%, a specificity of 90.91%, and an accuracy of 78.58%. The positive predictive value was 95.83% and the negative predictive value 55.56%. CONCLUSIONS: Patients with cirrhosis who are not candidates for liver transplantation are referred to hospice care at a late stage with an average survival of 1 month. The MELD score correlates with survival of cirrhosis patients enrolled in hospice and can be used to estimate 30-day mortality. Further, research is needed to determine a MELD score that predicts a survival of 6 months or less, an important determinant of appropriate hospice referrals.     

终末期肝病模型联合总胆汁酸对亚急性肝衰竭患者预后的评估

目的探讨终末期肝病模型（MELD）联合血清总胆汁酸（TBA）的检测对于判断亚急性肝衰竭患者预后的意义。方法亚急性肝衰竭患者110例,测定血清肌酐（CR）,TBil,凝血酶原时间国际标准化比值（INR）,TBA,根据公式计算MELD值,单一评估MELD,TBA及二者联合对亚急性肝衰竭患者预后的判断价值。结果恶化死亡组的MELD值及TBA均明显高于好转治愈组（P〈0.05）,MELD值、TBA值各组间病死率的比较具有统计学意义（P〈0.01）。将MELD值≥30,TBA值≥200联合判断患者病死率的敏感性和特异性分别为67.65%,97.37%,MELD值与TBA值呈正相关（r=0.9903,P〈0.01）。结论 MELD分值联合TBA可以提高亚急性肝衰竭患者预后判断的准确性     

MELD和MELD-Na评分系统评估失代偿期肝硬化患者预后的研究

目的比较Child-Pugh(CTP)分级、终末期肝病模型(Model for End-stage Liver Disease,MELD)评分系统及MELD联合血清钠(MELD-Na)对失代偿期肝硬化患者3、6、12个月死亡危险的预测价值。方法入选151例肝硬化失代偿期患者,根据随访3、6、12个月的存活情况,分别观察CTP分级、MELD评分及MELD-Na对肝硬化失代偿期患者死亡率的预测情况。结果151例入选病例中,随访至3个月时,不论是CTP、MELD还是MELD-Na随着各相应分值的增高,生存率均显著降低(P0.01),提示CTP、MELD及MELD-Na均能较好地预测患者短期生存率。随访至6个月及12个月时患者生存率的变化仍可见到这种趋势。本研究应用C-统计学分析,通过CTP、MELD及MELD-Na对比发现,随访至3个月时,CTP、MELD、MELD-Na的AUC分别为0.819、0.835、0.842;随访至6个月时AUC值为0.820、0.818、0.832;随访至12个月时AUC分别为0.795、0.795、0.814。MELD-Na的数值均高于CTP及MELD,但统计学无显著差异。结论CTP、MELD和MELD-Na均可以对终末期肝病患者预后做出较准确的判断。MELD-Na在预测肝硬化失代偿期患者短期生存率方面有一定优势。