终末期肝病模型评估肝硬化失代偿期患者的短期预后

占国清; 谭华炳; 李芳; 李儒贵; 张薇薇; 李金科

终末期肝病模型评估肝硬化失代偿期患者的短期预后

湖北医药学院附属人民医院肝病研究所

基金项目:

湖北省十堰市科技局2008年资助项目(SY2008-015)；

详细信息

中图分类号: R575.2
计量
- 文章访问数: 4242
- HTML全文浏览量: 12
- PDF下载量: 1062
- 被引次数: 0
出版历程
- 出版日期: 2011-03-20

Evaluation of model for end stage liver disease for estimation of short-term prognosis in decompensated cirrhosis

Research funding:

摘要

摘要: 目的评价终末期肝病模型（MELD）、MELD-Na、Child-Turcotte-Pugh（CTP）和包含血肌酐值的CTP（CrCTP）评分对肝硬化失代偿期患者短期预后的价值。方法选择265例具有完整住院资料和随访结果的肝硬化失代偿期患者为研究对象,分别计算每例患者人院后首次MELD、MELD-Na、CTP及CrCTP评分,并了解其3个月内的病死率。以受试者工作特征曲线（ROC）下面积（AUC）衡量各评分系统判断患者3个月生存的能力。结果 3个月内有58例死亡。死亡组MELD、MELD-Na、CTP及CrCTP分值（分别为22.15±5.67、31.45±8.50、11.60±2.70、12.72±2.54）均高于生存组（分别为12.35±3.56、17.24±4.75、8.73±2.35、9.05±2.50）（P<0.01）,两组在MELD分值和CTP分级的分布上差异具有统计学意义（P<0.01）。MELD、MELD-Na、CTP及CrCTP评分对肝硬化失代偿期患者3个月预后评估的ROC曲线下面积分别为0.875、0.868、0.758、0.794,MELD评估患者短期预...
- 肝硬化 /
- 预后 /
- 终末期肝病模型
Abstract: Objective To evaluate the short-term prognostic value of model of end stage liver disease (MELD) , MELD-Na, Child-Turcotte-Pugh (CTP) and the creatinine modified CTP (CrCTP) grading in patients with decompensated liver cirrhosis.Methods 265 patients with decompensated liver cirrhosis were enrolled in the study.The MELD, MELD-Na, CTP and CrCTP scores were calculated for each patient on the first time of admission and their mortality within 3 months was observed.Receiver operating characteristic curve (ROC) and the area under the curve (AUC) were used to analyze and compare the values of the four models to predict the 3-month survival.Results 58 patients died within 3 months.MELD, MELD-Na, CTP and CrCTP scores for non-survivors (22.15±5.67, 31.45±8.50, 11.60±2.70, 12.72±2.54) were significantly higher (P<0.01) than those for survivors (12.35±3.56, 17.24±4.75, 8.73±2.35, 9.05±2.50) .There were significant differences between the two groups in MELD and CTP grade (P<0.01) .For 3-month predictive prognosis, the area under ROC of MELD, MELD-Na, CTP and CrCTP were 0.875, 0.868, 0.758 and 0.794 respectively.MELD was superior to CTP in predicting short-term of patients with decompensated liver cirrhosis.There was no difference between MELD, MELD-Na and CrCTP.Conclusion MELD, MELD-Na, CTP and CrCTP scores can accurately predict the 3-month survival of patients with decompensated liver cirrhosis.The MELD score is superior to CTP score for estimation of short-term survival in patients with decompensated cirrhosis.
- liver cirrhosis /
- prognosis /
- model of end stage liver disease

HTML全文

参考文献(14)

[1]Freeman RB Jr, Wiesner RH, Harper A, et al.The new liver allocation system:moving toward evidence-based transplantation policy[J].Liver Transpl, 2002, 8 (9) :851-858.

[2]中华医学会.病毒性肝炎防治方案[J].中华肝脏病杂志, 2000, 8 (6) :324-329.

[3]Kamath PS, Wiesner RH, Malinehoc M, et al.A model to predict survival in patients with end-stage liver disease[J].Hepatology, 2001, 33 (2) :464-470.

[4]Biggins SW, Kim WR, Terrault NA, et al.Evidence-based incorporation of serum sodium concentration into MELD[J].Gastroenterology, 2006, 130 (6) :1652-1660.

[5] 陈灏珠.实用内科学[M].北京:人民卫生出版社, 1997:1673-1689.

[6]Papatheodoridis GV, Cholongitas E, Dimitriadou E.et al.ME-LD versus Child-Pugh and creatinine-modified Child-Pugh score for predicting survival in patients with deeompensated cirrhosis[J].World J Gastroenterol, 2005, 11 (20) :3099-3104.

[7]Everson GT.MELD:the answer or just more question?[J].Gastroenterology, 2003, 124 (1) :251-254.

[8]Salerno F, Merli M, Cazzaniga M, et al.MELD score is betterthan Child Pugh score in predicting 3-month survival of patients undergoing tranjugular intrahepatic portosystemicshunt[J].J Hepatol, 2002, 36 (4) :494-500.

[9]吴柳, 范竹萍.239例肝硬化失代偿期患者的短期预后评估[J].肝脏, 2009, 14 (1) :11-13.

[10]Angemayr B, Cejna M, Karnel F, et al.Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystem ic shunt[J].Gut, 2003, 52 (6) :879-885.

[11]Cholongitas E, Papatheodoridls GV, Vangeli M, et al.Systematic review:The model for end stage liver disease-should it replace Child Pugh's classification for assessing prognosis in cirrhosis?[J].Aliment Pharmacol Ther, 2005, 22 (11-12) :1079-1089.

[12]占国清, 谭华炳, 朱琳, 等.145例肝硬化失代偿期低钠血症的的回顾性分析[J].临床肝胆病杂志, 2010, 26 (2) :194-195, 198.

[13]Fernandez-Esparrach G, Sanchez-Fueyo A, Gines P, et al.A prognostic model for predicting survival in cirrhosis with ascites[J].J Hepatol, 2001, 34 (1) :46-52.

[14]Hanley JA, McNeil BJ.The meaning and use of the area under a receiver operating characteristic (ROC) curve[J].Radiology, 1982, 143 (1) :29-36.

施引文献

资源附件(0)

访问统计