终末期肝病模型评分差值对食管静脉曲张破裂大出血硬化治疗预后的判断价值

目的评估终末期肝病模型及差值对肝硬化食管静脉曲张破裂大出血硬化治疗短期(1个月、3个月、6个月)预后分析的价值。方法对具有完整病例资料和随访结果的76食管静脉曲张破裂大出血行硬化治疗的肝硬化患者进行回顾性分析,计算每例患者入院时的MELD、CTP评分以及随访期间的MELD,两次MELD之差为△MELD,以受试者工作曲线(ROC)下面积衡量CTP、MELD、△MELD对患者预后的预测能力,所有患者随访6个月以上。结果硬化治疗0~1个月、1~3个月、3~6个月内再出血或死亡病例分别为14、26、19人,未出血组和再出血或死亡组的CTP、MELD、△MELD值比较有统计学意义(P<0.01);CTP、MELD、△MELD对3个月预后评估的ROC线下面积分别为(0.73±0.06)、(0.85±0.05)、(0.88±0.42);对6个月预后评估的ROC线下面积分别为(0.61±0.10)、(0.85±0.07)、(0.96±0.03),三者间曲线下面积比较具有统计学意义(P<0.01)。结论△MELD可准确地预测食管静脉曲张破裂大出血行硬化治疗的肝硬化患者的短期预后,其准确性优于初期MELD及CTP评分,值得临床推广应用。

The Delta Value of End-stage Liver Disease in Prognosis for Patients with Massive Hemorrhage from Esophageal Varicosis by Sclerotherapy

Objective To evaluate the model of end-stage liver disease（MELD） and delta value of end-stage liver disease（△MELD） 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 cohort of 76 liver cirrhotic patients with massive hemorrhage from esophageal varicosis treated by EIS were analyzed retrospectively.MELD and Child-Turcotte-Pugh（CTP） score were calculated for each patients at admission and 1 month after.The △MELD was calculated by subtraction of two MELD score,The area under the receiver operating characteristic（ROC） curve was used to compare MELD,CTP score with △MELD in predicting rehaemorrhagia and death risk,the follow up period was at least 6 months.Results Sclerotherapy in 0~1month,1 ~ 3 months,3 to 6 months re-bleeding or deaths were 14,26,19 people,non-bleeding group and re-bleeding or death group of the CTP,MELD,△MELD values were statistically significance（P0.01）;For 3 month predictive prognosis,the area under ROC of CTP,MELD,△MELD were（0.73±0.06）、（0.85±0.05）、（0.88±0.42）,respectively（P0.01）;For 6 month predictive prognosis,the area under ROC of CTP,MELD,△MELD,were（0.61±0.10）、（0.85±0.07）、（0.96±0.03）（,respectively（P0.01）,There was statistical significance among the area under ROC of CTP,MELD,△MELD（P0.01）.Conclusion The results indicate that △MELD is superior than MELD and CTP score to predict the short-term prognosis of patient with massive hemorrhage from esophageal varicosis by sclerotherapy.,worthy of clinical application.