终末期肝病模型评价人工肝支持治疗肝衰竭的临床疗效

目的探讨终末期肝病模型（MELD）对人工肝血浆置换（PE）治疗肝衰竭疗效评价的临床应用价值。方法回顾性分析115例肝衰竭患者的临床资料,分别计算人工肝治疗组（PE组）和非人工肝治疗组（对照组）两组患者治疗前后MELD分值,观察90d内的临床转归,并根据MELD评分系统对肝衰竭患者的严重程度以及治疗效果进行量化分析,通过对比病死率及生存时间评价其疗效。结果经过人工肝治疗后1h,MELD分值较治疗前明显下降,但PE组与对照组治疗后30d的MELD分值无统计学差异。MELD分值在〈30,30～40,≥40不同范围内,PE组病死率分别为25%,35%,73%,对照组分别为22%,41%,83%,两组间比较无统计学差异（P〉0.05）。而PE组生存期比对照组延长（P〈0.05）。结论近期随访血浆置换治疗与内科治疗相比,不能明显降低病死率,但可以延长生存期,从而争取时机,等待肝细胞再生恢复或过渡到肝移植。

The value of MELD score for evaluation of plasma exchange in patients with liver failure

Objective To study the clinical significance of end-stage liver disease（MELD） scores for evaluation of the therapeutic effect of plasma exchange（PE） on acute liver failure.Methods A total of 115 patients with liver failure were divided into treatment group with ALSS（n = 62） and control group without ALSS（n = 53）.The MELD score were calculated,and the death rate and survival time were observed for three months.Both groups were graded with Model End stage Liver.The efficacy of plasma exchange was evaluated by comparing the MELD scores and survival rate of the treatment group with the control group.Results There was a decrease in MELD score but there was no significant difference between PE group and control group after 1 month of therapy.Compared to the control group,there was no significant decrease of death rate in the treatment group.The survival time was significantly longer in PE group（P 0.05）.Conclusion Compared to control group,plasma exchange did not decrease the death rate,but it can prolong the survival period in patients with liver failure.These results suggest the importance of potential temporary liver support until recovery or liver transplantation.