摘要
目的 评估终末期肝病模型（MELD）评分系统对慢性重型乙型肝炎患者短期（3个月）预后的预测能力及临床应用价值,并求出作为判断患者3个月内生存与否的MELD最佳临界值。方法 将139例慢性重型乙型肝炎患者临床资料按有无肝硬化进行分组,根据MELD评分公式对每位患者进行评分,观察3个月内的病死率,并绘制受试者工作特征曲线（ROC）。结果 ①所观察患者的MELD评分均在20分以上,其中慢性重型肝炎组（72例）的MELD评分为（31.34±7.00）分,肝硬化重型肝炎组（67例）的MELD评分为（31.97±6.82）分,两组MELD评分比较差异无显著性（P〉0.05）。②139例慢性重型乙型肝炎患者3个月内的总病死率为58.3%（81/139例）。MELD评分20-30、30-40和≥40分患者的病死率分别为35.6%（26/73例）、76.6%（36/47例）和100.0%（19/19例）,分值越高病死率越高,但MELD评分同一分值段的慢性重型肝炎组与肝硬化重型肝炎组间病死率比较差异均无显著性（P均〉0.05）。应用该模型预测患者3个月内死亡与否的MELD最佳临界值为31,ROC下面积为0.809,敏感性为64.2%,特异性为91.4%。结论 患者发病时有无肝硬化的基础可能对慢性重型乙型肝炎患者的短期预后影响不大;MELD评分能够作为反映慢性重型乙型肝炎患者病情严重程度的指标,MELD能够较准确地预测我国慢性重型乙型肝炎患者短期临床预后。
Objective To study the practical clinical use of the model for end -stage liver disease （MELD） and assess its validity in predicting the short -term （3 mouths） prognosis of patients with chronic severe hepatitis B. The optimal cut- off values of MELD to discriminate between deceased and surviving patients were calculated by using receiver operator characteristic （ROC） curve. Methods The clinical information of 139 patients with chronic severe hepatitis B was collected. The patients were divided into two groups, including cirrhosis group and non- cirrhosis group （chronic hepatitis group）. All the patients were evaluated with MELD. The death rate was recorded within 3 months. Results ①The scores of MELD in all patients were higher than 20 points. The value of MELD between chronic hepatitis group （（31.34 ±7.00） scores, n=72] and cirrhosis group （（31.97± 6.82） scores, n = 67] had no significant difference （P〉0.05）. The mortality between the two groups had no significant difference, too. ②The mortality within 3 months was 58.30/4 （81/139 cases）. The mortality of the patients whose MELD score were 20 -30 points, 30 -40 points and higher than 40 points were 35. 6% （26/73 cases）, 76.6% （36/47 cases） and 100% （19/19 cases）, respectively. Comparing with the higher scores the mortality was increased at the same MELD score. There were no significant difference in mortality between chronic severe hepatitis B and cirrhosis Severe hepatitis B （all P〉0.05）. The optimal cut -off value of MELD score to predict the prognosis of patients was 31, with sensitivity and specificity were 64.2% and 91.4%, respectively, and c-statistic was 0. 809 （95% CI 0. 738 -0. 879）. Conclusion The onset of chronic liver failure based on cirrhosis might have no important effect on the short -term prognosis. The MELD score can serve as an index of the severity of patients with chronic severe hepatitis B, and it can be used to predict accurately the short - term prognosis.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2007年第7期416-418,共3页
Chinese Critical Care Medicine
关键词
肝炎
乙型
重型
慢性
终末期肝病模型评分
预后
chronic severe hepatitis B model for end -stage liver disease score
prognosis
