终末期肝病模型判断肝硬化患者预后的价值

目的终末期肝病模型(MELD)是2000年由美国的Malinchoc等建立的一个判断终末期肝硬化患者新的预后模型,本研究旨在验证MELD判断我国肝硬化患者预后方面的价值。方法选择具有完整记录资料和随访结果的315例肝硬化患者进行分析,根据MELD公式计算每例患者的MELD值及Child-Turcotte-Pugh(CTP)评分和分级。运用受试者工作曲线(ROC曲线)及其曲线下面积(AUC)比较MELD、CTP评分和分级判断肝硬化患者生存3个月、1年、2年等不同时间的准确性。运用Kaplan-Meier生存分析,比较不同MELD值时患者的生存率变化。结果MELD在判断患者3个月、1年、2年等生存时间的ROC曲线AUC均大于0.8,并且均大于CTP分级或评分的面积;除与CTP分级在判断6个月、1年、3年和4年时的AUC差异有统计学意义外,在其余时间内两者之间的AUC差异无统计学意义。MELD和CTP评分在两者之间的AUC差异均无统计学意义。将患者依据MELD值分成4组后,不同分级内的生存率均存在明显差异(P<0.001)。结论MELD在判断肝硬化患者预后方面是一个很好的指标,但与CTP分级或评分相比,三者判断能力无明显差异。

The prognostic value of end-stage liver disease model in liver cirrhosis

Objectives The prognostic ability of the model for end-stage liver disease(MELD) has been validated in many countries,but its abilities remain uncertain in China.Our aim is to evaluate the abilities of MELD in prognosis of liver cirrhosis.Methods A cohort of 315 patients with liver cirrhosis were retrospectively studied and followed up at least for one year.MELD score was obtained for each patient according to the modified formula by Kamath P.S..The area under the receiver operating characteristic(ROC) curve(AUC) was used to compare MELD and Child-Turcotte-Pugh(CTP) score and classification in predicting accuracy.Kaplan-Meier survival analysis was used to compare the mortality in subgroups ranked by the MELD score.Results The AUC values generated by the ROC curves for the MELD were 0.95,0.85 and 0.83 respectively in predicting 3,6 month and 1 year survival,and were all more than 0.80 in predicting longer time survival,whereas the AUC was 0.82,0.78,0.74 for CTP score and 0.70,0.66,0.61 for CTP classification respectively in predicting 3,6 month and 1 year survival.The differences of AUCs between the MELD and CTP classification were significant in predicting 6 month and 1,3 and 4 year survival, but were not significant in predicting other time point survival.The differences of AUCs between the MELD and CTP score were not significant in predicting survival.In the subgroups of patients ranked by MELD score lower than 10,10 to 20,20 to 30,and more than 30,the survival rate was significant different(P=0.000).Conclusions MELD is a useful prognosis indictor for the liver cirrhosis.The ability of prognosis by MELD is similar to Child-Turcotte-Pugh classification and score.