30例肝移植病例MELD分析

目的探讨终末期肝病模型（MELD）评分评估终末期肝病患者行肝移植术后，受者短期预后、肝移植的手术时机以及MELD与肝脏病理的关系。方法对30例肝移植病例进行回顾性分析，比较术后随访30天后存活组（12例）与死亡组（18例）的术前MELD评分，以MELD分值25和30为界线将病例分组，比较存活率以及肝脏病理，分析大块、亚大块肝细胞坏死与非大块、亚大块肝细胞坏死病例的MELD分值。结果所有患者术前MELD评分平均值为28．92±13．45，术后随访3个月总生存率为40％，其中存活组与死亡组术前MELD评分分别为21．56±11．83和33．82±12．43（P〈0．05）；以MELD评分25为界将患者分为两组，术后3个月存活率为63．6％和26．3％（P〈0．05）；以MELD评分30为界将患者分为两组，术后3个月存活率为53．3％和26．7％（P〉0．05）：大块、亚大块肝细胞坏死组与非大块、亚大块肝细胞坏死组患者术前MELD值相比有显著差异，分别为22．38±12．69和33．28±12．41（P〈0．05）。结论MELD评分可评估肝移植受术者的短期预后，肝移植受者MELD评分值在25分时比30分时行肝移植术更有意义，MELD评分与肝细胞坏死面积有关。

MELD analysis on 30 cases of liver transplant patients

Objective To evaluate the model of end-stage liver disease （MELD） score in predicting short-term prognosis of patients with end-stage liver disease after liver transplantation, optimal surgery time for hver transplantation, as well as the relation between MELD score and liver pathology. Methods Thirty cases of liver transplantation were analysed retrospectively, the preoperative MELD score between the survival group （12 cases） and death group （18 cases） 30 days after operation were compared. The cases were divided according to the MELD score 25 and 30 and survival rate were compared. According to liver pa- thology, the MELD score between the large and sub-massive hepatocyte necrosis group and non-large and non-sub-massive hepatocyte necrosis group were compared. Results The average MELD score of all patients was 28.92 ＋ 13.45, the total survival rate was 40% after 3 months, MELD score of survival group and death group were 21.56 ± 11.83 and 33.82 ± 12.43 （ P 〈 0.05 ） ; patients were divided into two groups with MELD score of 25 as dividing line, the survival rate of the two groups below 25 and above 25 were 63.6% and 26.3% （P 〈 0.05 ）, respectively; patients were divided into two groups with MELD score of 30 as dividing line, the survival rate of the two groups below 30 and above 30 group were 53.3% and 26.7% （P 〉 0.05 ） , respectively ; MELD score of large and sub-massive hepatocyte necrosis group and non-large and non-sub-massive hepatoeyte neerosis group were 22.38 ~ 12.69 and 33.28 ~ 12.41 （P 〈 0.05 ）, respectively. Conclusions MELD score can assess the short-term prognosis of liver transplant recipients ; it is more meaningful to do operation when the MELD score of patients was 25 ; MELD score was related to the area of hepatoeyte necrosis.