终末期肝病模型评估我国肝硬化患者预后的能力

目的：评价终末期肝病模型(MELD)在评估我国肝硬化患者预后方面的作用．方法：选择具有完整临床资料和随访结果的216例肝硬化患者进行回顾性分析．利用受试者工作特征曲线(ROC)及其下面积(AUC)比较MELD、美国器官共享网络(UNOS)修改后的MELD(U-MELDl、Child-Turcotte- Pugh(CTP)评分及分级判断预后的能力．每位患者的MELD值根据Kamath修改后的公式计算,U-MELD值根据UNOS修改后的计算方法计算．AUC的比较采用非参数方法．结果：MELD在判断患者3,6 mo,1a等生存时间的ROC曲线AUC值分别是0．838．0．856．0．877,均大于CTP评分及分级的AUC值．与CTP分级有显著性差异,但与CTP评分无显著性差异．U-MELD在判断3mo预后时的AUC值与CTP评分的差异有统计学意义(P=0．028),而在6mo,1a时两者间的AUC差异尚无统计学意义．结论：MELD与CTP评分的差异无统计学意义,而U-MELD在评估3mo预后方面较CTP评分已有显著优势．

Capability of end-stage liver disease model in predicting the prognosis of Chinese patients with liver cirrhosis

AIM:To evaluate the capability of the model for end-stage liver disease(MELD)in predicting the prognosis of Chinese patients with liver cirrhosis. METHODS:A cohort of 216 patients with liver cirrhosis were retrospectively studied and fol- lowed up.The area under the receiver operating characteristic(ROC)curve(AUC)was used to compare MELD,U-MELD(MELD modified by the United Network for Organ Sharing),Child- Turcotte-Pugh(CTP)score and classification in predicting accuracy.MELD score was obtained for each patient according to the modified for- mula by Kamath.U-MELD score was obtained according to the modified formula by the United Network for Organ Sharing(UNOS).Nonpara- metric approach was applied for the comparison of AUC. RESULTS:The AUC value generated by the ROC curve for MELD was 0.838 at 3 mo,0.856 at 6 mo and 0.877 at 1 year.MELD was better than CTP classification,and there was significant difference between them.However,there was no significant difference between MELD and CTP score.U-MELD was more accurate than CTP score in predicting the 3-mo prognosis(P= 0.028),while it did not show significant superi- ority in predicting 6-too and 1-year prognosis. CONCLUSION:There is no significant dif- ference between MELD and CTP score,but U-MELD is superior to CTP score in predicting the 3-mo prognosis.