终末期肝病模型评估失代偿期肝硬化患者预后的价值

目的: 评价终末期肝病模型(model for endstage liver disease,MELD)对肝硬化患者短期预后预测的价值.方法: 对肝硬化失代偿期患者203例进行回顾性分析,随访患者在3、6及12 mo内的预后. 记录每例患者入院第1天的MELD及Child-Turcotte-Pugh(CTP)评分. 应用接受者工作特征曲线(ROC曲线)及其曲线下面积(AUC)比较MELD、CTP评估患者生存时间的准确性. 依据ROC曲线的截断值绘制Kaplan-Meier生存曲线,应用非参数秩相关即Spearman等级相关检验分析MELD与CTP评分的相关性.结果: 3、6及12 mo内分别死亡23、39、85例,MELD评分与CTP评分均显著相关( r = 0.76,0.69,0.71,均P<0.01). 3、6及12 mo内MELD与CTP对住院患者预后预测的AUC分别为0.886和0.775( P<0.01)、0.892和0.876( P>0.05)、0.873和0.866( P>0.05). 生存分析表明2评分系统均可有效预测3、6及12 mo内患者可能的生存率和死亡率( P<0.01).结论: MELD模型可预测失代偿肝硬化患者12 mo内的生存率,3 mo内MELD模型优于CTP评分,但6 mo及12 mo内MELD模型和CTP评分相比没有明显优势.

Values of end-stage liver disease model in assessment of prognosis in patients with decompensated liver cirrhosis

AIM: To compare the prognostic values of for end-stage liver disease (MELD) model and Child-Turcotte-Pugh (CTP) for patients with decompensated liver cirrhosis.METHODS: From a previously collected database,203 patients with decompensated liver cirrhosis admitted to our hospital were studied and followed up at least for one year. MELD and CTP score and classification were calculated on entry. Receiver operating characteristics curves (ROC) and the area under ROC were used to determine the ability of the scores for predicting three,six and twelve month mortality. Kaplan-Meier survival analysis (K-M) was performed using the cut-offs to establish the predictive power of each score.RESULTS: There were 23,39 and 85 dead cases within 3,6 and 12 mo respectively. There was a significant correlation between the MELD and CTP score in 3,6 and 12 mo (r = 0.76,0.69,0.71,P < 0.01). The areas under the receiver operating characteristics curves of MELD and CTP for the occurrence of death in 3 mo were 0.886 and 0.775.There was a significant difference in the 3 mo between two scores (P < 0.01). The areas under the receiver operating characteristics curves for MELD was 0.892 compared with 0.876 for CTP at 6 mo (P > 0.05);the area was 0.873 and 0.886respectively at 12 mo (P > 0.05). Both MELD and CTP scores predicted the death rate and survival rate within 3,6 and 12 mo by survival analysis (P < 0.01).CONCLUSION: MELD is a strong prognosis predictor for the decompensated liver cirrhosis.MELD was significantly better than CTP score for predicting in-hospital mortality in 3 mo.However,these are not superior to CTP score and CTP classification in 6 and 12 mo.