终末期肝病模型用于慢性重症肝炎患者肝移植预后的评估

目的 探讨终末期肝病模型(MELD)预测慢性重症肝炎患者肝移植后早期存活率的价值.方法 共有42例慢性重症肝炎患者接受了肝移植,所有患者的原发病均为乙型肝炎.按照2000年修订的重症肝炎临床分期标准,19例为早期,16例为中期,7例为晚期.Child-Pugh分级,除1例为B级外,其余均为C级.对所有患者进行MELD评分和Child-Pugh评分,并进行比较.绘制ROC曲线,根据ROC曲线下面积评估MELD评分和Child-Pugh评分对肝移植后早期死亡率的预测价值.依据两种评分的ROC曲线临界值,分别绘制Kaplan-Meier生存曲线,Log-Rank检验比较生存曲线的组问差异.采用Spearman等级相关检验分析两种评分方式的相关性.结果 随访至术后3个月,42例中,死亡7例.死亡者的MELD评分和Child-Pugh评分分别为(32.97±7.11)分和(12.57±0.98)分,明显高于存活者的(24.90)±4.96)分和(11.51±1.17)分(P＜0.01,P＜0.05).MELD评分评估患者术后3个月内存活率的最佳临界值是25.67,敏感性和特异性分别是85.7 %和60.0 %,ROC曲线下面积为0.841.Child-Pugh评分评估患者术后3个月内存活率的最佳临界值是11.5,敏感性和特异性分别是85.7 %和54.3 %,ROC曲线下面积为0.747.根据两种评分方法绘制的Kaplan-Meier生存曲线均能有效区分可能死亡和可能存活的患者.Spearman等级相关分析表明两种评分方法的相关系数为0.307(P＜0.05).结论 MELD评分和Child-Pugh评分对慢性重症肝炎患者肝移植后早期存活率均有预测价值;MELD评分能够更好的预测慢性重型肝炎患者术后近期死亡率.

Impact of pretransplant MELD score on posttransplant outcome in orthotopic liver transplantation for patients with acute-on-chronic hepatitis B liver failure

Objective To evaluate the usefulness of the model for end-stage liver disease(MELD)score in comparison with the Child-Turcotte-Pugh(CTP)score to predict postoperative short-term survival and 3-month morbidity in patients with acute-on-chronic hepatitis B liver failure undergoing orthotopic liver transplantation. Methods Data of all patients undergoing orthotopic liver transplantation in our unit;from December 1999 to November 2005,were analyzed retrospectively.MELD and CTP scores were calculated for each patient according to the original formula on the admission day.MELD and CTP accuracy in predicting postoperative short-term survival and 3-month morbidity was assessed using receiver operating characteristic(ROC)analysis and Kaplan-Meier analysis respectively.Resuiis Seven out of 42 patients died within 3-month follow-up.MELD scores in non survivors(32.97±7.11)were higher than those in survivors(24.90±4.96)significantly(P＜0.01),and CTP scores were significantly highter too(12.57±0.98 vs. 11.51±1.17,P＜0.05).ROC analysis identified that the MELD best cutoff point was 25.67 in predicting postoperative morbidity(area under the curve[AUC]=0.841;sensitivity=85.7 %;specificity=60.0 %),and the CTP best cutoff point was 11.5(AUC=0.747;sensitivity=85.7 %;specificity=54.3 %).MELD score was a better method than CTP score for predicting the postoperative short-term survival and 3 month morbidity in patients with acute-on-chronic hepatitis B liver failure undergoing orthotopic liver transplantation.Conclusion MELD score was an objective predictive system and was more efficient than CTP score in evaluating the risk of 3-month morbidity and short-term prognosis in patients with acute-on-chronic hepatitis B liver failure undergoing orthotopic liver transplantation.