摘要
目的 探讨临床应用整合终末期肝病模型（iMELD）评估慢性乙型重型肝炎患者短期预后的价值.方法 回顾性分析180例慢性乙型重型肝炎患者的病例资料,依据是否发生肝炎肝硬化情况分为非肝硬化组（120例）和肝硬化组（60例）,均通过iMELD评估短期的预后情况.结果 本研究数据显示,两组iMELD评分、MELD评分、血清钠、Cr差异均有统计学意义（t=6.734、7.135、7.231、8.264,均P＜0.05）;非肝硬化组中生存患者与死亡患者的iMELD评分、MELD评分、PT、PT的INR和Cr差异均有统计学意义（t=7.712、6.854、7.302、9.496、7.302,均P＜0.05）;肝硬化组中生存患者与死亡患者的iMELD评分、MELD评分、PT、INR差异均有统计学意义（t=7.022、7.214、7.126、6.563,均P＜0.05）.两组＜30分、30～40分、41～50分、51～60分和＞60分阶段的病死率差异均无统计学意义（χ2=0.151、1.402、1.021、2.351、0.241,均P＞0.05）.应用iMELD预测患者3个月内的预后分析,慢性乙型重型肝炎的ROC曲线下面积为0.721,标准误差为0.021,95.0%的可信区间为0.452～0.772,预后ROC曲线的最佳临界值是44.62分,敏感度51.0%,特异度88.3%.结论 iMELD对是否存在有肝硬化的慢性乙型重型肝炎患者的短期预后评估效果差异不大,但是采取iMELD能够有效地判断慢性乙型重型肝炎的病情程度,值得临床中应用.
Objective To investigate the clinical value of the integration of the model for end-stage liver disease （iMELD） in evaluating the short-term prognosis of chronic severe hepatitis B patients. Methods The clinical data of 180 patients with chronic severe hepatitis B were retrospectively analyzed. According to with cirrhosis or non-cirrhosis,the patients were divided into non-cirrhosis group （120 cases ） and cirrhosis group （60 cases ）. The short-term prognosis was evaluated by iMELD. Results The iMELD score, MELD score,serum sodium, serum creatinine had obvious differences between the two groups （ t = 6. 734,7. 135,7. 231,8. 264, all P 〈 0.05 ）. In non-cirrhosis group,the iMELD score, MELD score, prothrombin,international normalized ratio and creatinine had significant differ- ences between survived and died patients （ t = 7. 712,6. 854,7. 302,9. 496,7. 302, all P 〈 0.05 ）. In cirrhosis group, the iMELD score, MELD score, prothrombin, international standard the ratio had obvious differences between survived and died patients （ t = 7. 022,7. 214,7. 126,6. 563, all P 〈 0.05 ）. The mortality of 〈 30,30-40,41-50,51-60 and 〉 60 points between the two groups had no significant differences （ X2 = 0. 151,1. 402,1. 021,2. 351,0. 241, all P 〉 0.05）. iMELD was used to evaluate the prognosis of 3 months, ROC curve area of chronic severe hepatitis B was 0. 721 ,the standard error was 0. 021, the 95% confidence interval was 0. 452-0. 772, the optimal critical value of prognosis of ROC curve was 44.62 ,the sensitivity was 51.0% ,the specificity was 88.3%. Conclusion The iMELD in evaluating the short-term prognosis of chronic severe hepatitis B patients with or without cirrhosis has no significant difference,but iMELD can effectively judge the severity of chronic severe hepatitis B, it is worthy of clinical application.
出处
《中国基层医药》
CAS
2014年第3期341-343,共3页
Chinese Journal of Primary Medicine and Pharmacy
关键词
肝炎
乙型
慢性
模型
统计学
预后
Hepatitis, type B, chronic
Models, statistical
Prognosis
