终末期肝病模型及CTP评分和分级判断食管静脉曲张破裂大出血患者预后的价值

目的 评价终末期肝病模型(MELD)及Child-Turcotte-Push(CTP)在判断行急诊硬化术(EIS)的肝硬化食管静脉曲张破裂大出血患者半年、1年预后方面的价值.方法 在行首次急诊EIS的肝硬化食管静脉曲张破裂大出血患者中,获取有完整临床资料和随访结果的65例患者进行回顾性分析,分析MELD与CTP评分及其分级的相关性.应用接收者工作特征曲线(ROC曲线)及其下的面积评价MELD、CTP评分及分级判断行急诊EIS后患者死亡风险的准确性.获取MELD及CTP评分判断患者预后死亡风险的最佳临界值.结果 MELD、CTP评分和CTP分级之间,均有明显的相关性.随访半年死亡7例,随访1年死亡9例.在随访半年和1年中,存活组和死亡组间,性别、年龄和血清胆红素相比差异无统计学意义,而血清肌酐、凝血酶原时间的国际标准化比值(INR)、CTP评分及MELD评分差异有统计学意义.MELD在判断患者半年和1年的预后方面其ROC曲线下面积均大于0.8,并均大于CTP评分和CTP分级的面积,但差异无统计学意义.MELD和CTP评分的最佳临界值均具有较好的死亡风险判断力.结论 MELD在判断行急诊EIS的肝硬化食管静脉曲张破裂大出血患者半年、1年预后方面具有较好的参考性,对EIS病例的选择具有指导意义.CTP评分及其分级判断患者短期、中期预后方面准确度为中等,但并不明显弱于MELD.

Model of end-stage liver disease and Child-Turcotte-Pugh in prognosis for patients with massive hemorrhage from esophageal varicosis

Objective To evaluate the model of end-stage liver disease (MELD) and Child-Tur-cotte-Pugh (CTP) in prognosis for cirrhotic patients with massive hemorrhage from esophageal varieosis, who underwent emergency endoscopic sclerotherapy (EIS). Methods The clinical and follow-up data of a co-hort of 65 liver cirrhotic patients with massive hemorrhage from esophageal varicosis treated by EIS were ana-lyzed retrospectively. Correlation between MELD values and CTP score and classification was analyzed. The area under the receiver operating characteristic (ROC) curve was used to compare MELD with CTP score and classification in predicting mortality risk. The optimal threshold of MELD to determine the prognostic death risk was calculated by ROC curves. Results MELD, CTP score and classification correlated signifi-cantly with each other. Seven patients died within six months and 9 died within the first year of follow-up.There was no significant difference in gender, age and serum bilirubin between the survival and death groups, while the serum creatinine, international normalized ratio (INR), CTP score, and MELD score were significantly different. The areas under the ROC curve of MELD were both greater than 0.8 to predict 6-month and 1 -year survival, and also were greater than those of CTP score and classification. Areas under the ROC curve of MELD is superior to, but not significantly different though, CTP score or classification. The optimal threshold values of MELD and CTP score both showed satisfactory predicting accuracy of mortality risk. Conclusion MELD is an accurate predictive system for 6 months and 1 year in liver cirrhotic patients with massive hemorrhage from esophageal varicosis treated by EIS. The MELD value is very important in the selection of patients for E1S. But it is not more efficient than CTP score and classification.