重型肝炎的终末期肝病模型预后回顾性分析

目的 通过终末期肝病模型(MELD)评分重型肝炎患者人工肝治疗后3个月时预后的回顾性分析,探索其临床应用价值及人工肝支持系统的治疗效果.方法 156例重型肝炎患者分为血浆置换(PE)组和非PE组,观察两组在治疗前和治疗后2周MELD的评分变化及3个月时的病死率.结果 治疗后2周PE组胆红素、INR、肌酐、MELD分值及在20～29、30～39组MELD分值较非PE组均显著降低(P＜0.01).PE组病死率及MELD分值在20～29和30～39范围的病死率明显低于非PE组,MELD评分越高,病死率越高,MELD分值≥40患者病死率,PE组和非PE组均为100%.结论 人工肝治疗重型肝炎患者有较好的疗效,患者短期内病死危险性随MELD分值的增加而上升,MELD评分系统能较准确预测重型肝炎患者短期的临床预后.

A retrospective analysis of prognosis on patients with severe hepatitis using the model for end-stage liver disease

Objective To study the practical use of the model for end-stage liver disease(MELD) in clinics and the role of artificial liver support system(ALSS) in end-stage liver disease by retrospective analysis of prognosis on patients with severe hepatitis.Methods 156 patients with severe hepatitis were divided into a plasma exchange(PE) group and a non-plasma exchange(non-PE) group,changes of MELD score before and after PE treatment 2 weeks and the death rate within 3 months were observed.Results After treatment 2 weeks serum bilirubin,INR,Cr,MELD score and MELD in 20~29,30~39 group were significant lower in PE group than non-PE group(P<0.01).The mortality rate and MELD score in PE group were significant lower than those in non-PE group.The higher MELD score,the higher mortality rate of patients.The mortality rates of patients were 100% in PE group and non-PE group when MELD score was above 40.Conclusion ALSS has good therapeutic efficacy in the treatment of severe hepatitis.The mortality rates of patients increase with their MELD scores.MELD can accurately predict the short-term prognosis of patients with severe hepatitis.