终末期肝病模型评分对预测2型肝肾综合征患者预后的意义

目的探讨终末期肝病模型(MELD)评分对预测2型肝肾综合征(HRS)患者预后的意义。方法以台州市中心医院100例2型HRS患者为研究对象。记录患者的肝肾功能、电解质、凝血功能、血常规、治疗方法和转归,计算MELD评分。自确诊之日起,随访3个月。随访期间死亡患者被纳入死亡组,存活患者纳入存活组。应用多元回归分析探讨2型HRS患者预后的影响因素。结果 (1)死亡组患者血肌酐、尿素氮、总胆红素水平及MELD值均显著高于存活组,差异均有统计学意义(P<0.05);而两组在年龄、性别构成、脑病、消化道出血、脓毒症、丙氨酸氨基转移酶(ALT)、清蛋白、尿酸、白细胞计数、血红蛋白水平、血小板计数、国际标准化比率(INR)和C反应蛋白(CRP)方面比较,差异均无统计学意义(P>0.05)。(2)多元回归分析显示,MELD每升高1个单位,死亡风险增加33.8%;总胆红素每升高1个单位,死亡风险增加20.5%;血肌酐每升高1个单位,死亡风险增加18.5%。结论 MELD评分可预测2型HRS患者3个月内的死亡风险。

Significance of MELD Score on the Prognosis for Patients with Type 2 Hepatorenal Syndrome

Objective To explore the significance of the end-stage liver disease(MELD) scores on the prognosis of patients with type 2 hepatorenal syndrome(HRS). Methods 100 patients with type 2 HRS from Taizhou Central Hospital were involved into the study.Liver and kidney function,electrolyte,coagulation function,blood routines,treatment and sequelae were recorded and MELD score were calculated.All the patients were followed up for three months after confirmation of the disease.Those who died during following up were categorized into death group,while those who survived into survival group.Multiple regression analysis was used to analyze the influencing factors for the prognosis of type 2 HRS patients. Results(1) Patients in the death group had significantly higher levels of creatinine,urea nitrogen and total bilirubin and a higher MELD value compared with survival group(P<0.05).While the differences between the two groups in age and sex structures,encephalopathia,bleeding of the gastro intestinal tract,pyemia,ALT,albumin,uric acid,white blood cell count,hemoglobin level,platelet count,INR and CRP were not statistically significant(P>0.05).(2) Multiple regression analysis showed that mortality risk would increase by 33.8% when MELD increased by one unit;mortality risk would increase by 20.5% when total bilirubin increased by one unit;mortality risk would increase by 18.5% when creatinine increased by one unit. Conclusion MELD score can predict mortality risk within three months in patients with type 2 HRS.