重型肝炎的终末期肝病模型预后分析

目的采用终末期肝病模型（Model for End—Stage Liver Disease，MELD）进行尝试，评估该模型评分系统对重型肝炎患者短期（3个月）预后的预测能力及临床应用价值，应用c-统计值（concordance statistic）评估MELD模型的预测准确性，该值等同于受试者工作特征曲线（Receiver Operating Characteristic Curve，ROC曲线）的曲线下面积，并求出作为判断患者3个月内死亡与否的MELD最佳临界值。方法121例住院患者随机分为血浆置换（plasma exchange，PE）组与非血浆置换组，应用MELD模型公式对每个患者进行评分，观察3月内的死亡率。结果81例患者在3个月内死亡（PE组35例，非PE组46例），MELD分值在20—30和30～40的患者的死亡率，PE组分别为36．8％、57．7％，而非PE组分别为64．9％、87．5％，PE组患者死亡率明显低于非PE组，差异有统计学意义（P〈0．05）。MELD分值达到并超过40的患者的死亡率，PE组为86．7％；非PE组为100％，两组的差异没有统计学意义（P〉0．05）。应用该模型预测患者3个月内死亡与否的最佳MELD临界值，PE组为30，敏感性80．0％，特异性52．0％，c-统计值为0．777；而非PE组分别为25，82．6％，86．7％及0．869。结论本研究认为MELD分值能够作为反映重型肝炎患者病情严重程度的指标，患者短期内（3个月）死亡危险性随MELD分值的增加而上升，MELD模型能较准确预测重型肝炎患者短期的临床预后。

Analysis of prognosis on patients with severe hepatitis using the criterion of model for end-stage liver disease

Objective To study the practical use of the model for end-stage liver disease （MELD） on clinic to assess its validity in predicting the prognosis of the patient with severe hepatitis. Methods 121 patients were divided randomly into plasma exchange group and none plasma exchange group, and they were graded with MELD formula. The death rate was observed within three months. Results 81 patients were died within 3month （35 cases in PE group, 46 cases in non-PE group）. The mortality of patients in PE group whose MELD score between 20 - 30 and 30 - 40 were 36.8% and 57.7% respectively; but in non-PE cases they were 64.9% and 87.5% respectively. There were significant differences between PE group and non-PE group（P〈0.05）. However, the mortality of patients whose MELD score higher than 40 were 86.7% in PE group and 100% in non-PE group, there were no significant difference between the two groups （P〉0.05）. Conclusions This study suggests that the MELD score can be act as a disease＇s severity index for patients with severe hepatitis, and the mortality of the patient increases with the increase in the MELD score. The MELD can accurately predict the short-term prognosis of patients with severe hepatitis.