应用终末期肝病模型评分系统预测血浆置换治疗后重型肝炎患者的预后  

Plasma exchange treatment using MELD scoring system improve the prognosis of fulminant Hepatitis in Chinese patients

作　　者：于建武[1] 王贵强[2] 赵勇华[1] 王淑琴[1] 李树臣[1] 

机构地区：[1]哈尔滨医科大学附属第二医院感染病科,150086 [2]北京大学第一医院感染性疾病科

出　　处：《中华传染病杂志》2006年第4期261-264,共4页Chinese Journal of Infectious Diseases

基　　金：黑龙江省教育厅科学技术研究项目(11511233)

摘　　要：目的应用终末期肝病模型(MELD)评分系统预测血浆置换(PE)治疗后重型肝炎患者的预后。方法160例重型肝炎患者随机分为PE组与对照组,应用MELD评分系统对每个患者进行评分,比较两组患者病死率和治疗前后的临床生化指标,探讨与MELD评分的关系。结果MELD分值在30～39的患者PE后总胆红素(TBIL)、凝血酶原时间国际标准化比值(INR)、MELD评分分别为(379．4±40．4)μmol/L、(2．5±0．2)和(30．8±3．8);明显低于治疗前的(509．7±64．6)μmol/L、(3．5±0．3)和(37．3±3．5),差异有统计学意义(P＜0．05)。PE组患者的病死率为50．0%,明显低于对照组的86．7%,差异有统计学意义(P＜0．01)。MELD分值≥40的患者PE后的TBIL、INR及MELD评分分别为(595．6±61．5)μmol/L、(3．8±0．4)、(39．8±3．50),明显低于治疗前的(650．4±66．3)μmol/L、(4．4±0．60)、(45．2±4．2),差异有统计学意义(P＜0．05)。PE组患者病死率为91．2%,与对照组的100%相比,差异无统计学意义(P＞0．05)。结论PE通过降低重型肝炎患者的TBIL、INR、MELD评分,改善肝脏功能。血浆置换可降低MELD分值在30～39之间的重型肝炎患者的病死率,但不能降低MELD分值≥40的患者的病死率。Objective To study prognosis of patients with fulminant hepatitis after plasma exchange treatment using model for end-stage liver disease（MELD） scoring system. Methods 160 patients were randomly divided into plasma exchange group and control group, and MELD score was calculated according to the original formula for each patient. The efficacy of plasma exchange was assessed by mortality and improvement in biochemical parameters and MELD score. Results The levels of total bilirubin（TBIL）, INR and MELD score of patients whose MELD scores were between 30 and 40 [TBIL, （379.4 ± 40.4 ） μmol/L; INR, 2.5± 0. 2; MELD, 30. 8 ± 3.8] were lower than before PE treatment [TBIL, （509.7 ± 64.6） μmol/L; INR, 3.5 ± 0. 3 ; MELD, 37.3 ± 3.5]. The levels of TBIL and INR and MELD score of patients whose MELD scores were higher than 40 ETBIL, （595.6± 61.5） μmol/L; INR, 3.8 ± 0. 4; MELD, 39. 8 ± 3. 5] were lower than before PE treatment [TBIL, （650. 4 ±66.3） μmol/L; INR, 4.4±0. 6; MELD, 45. 2±4.2]. The mortality of patients in PE group with MELD score from 30 and 40 was 50.0%, while it was 86. 7% in control group, showing significant difference between PE group and control group （P 〈 0. 01）. The mortality of patients with MELD scores higher than 40 was 91. 2% in PE group and 100% in control group, showing no significant difference between these two groups （P 〈 0.05）. Conclusions Plasma exchange treatment can decrease the serum TBIL level, INR and MELD score of patients with fulminant hepatitis and improve liver function. Compared with the control group, plasma exchange can significantly dccrease the mortality of patients in PE group with MELD score from 30 to 40, but no effect on patients with MELD score higher than 40.

关 键 词：肝炎 病毒性 人 血浆置换 终末期肝病模型 病死率 

分 类 号：R575.1[医药卫生—消化系统]