终末期肝病模型对肝移植术后生存率的预测  

Prediction of survival rates after liver transplantation by the model of end-stage fiver disease

作　　者：刘景丰[1] 林科灿[1] 彭志海[2] 李毅碧[1] 林建扬[1] 李灵[1] 邱明链[1] 程智清[1] 

机构地区：[1]福建医科大学附属第一医院肝病中心,福州350005 [2]上海市第一人民医院普外科,200080

出　　处：《中华消化外科杂志》2007年第6期436-438,共3页Chinese Journal of Digestive Surgery

摘　　要：目的探讨终末期肝病模型（model of end-stage liver disease，MELD）对良性终末期肝病肝移植患者生存率预测的价值。方法回顾性分析170例良性终末期肝病肝移植患者的临床资料，利用受试者工作特性曲线下面积（c-statistic值）评价MELD或Child-Turcotte-Pugh（CTP）评分预测患者肝移植术后生存时间的准确性。根据MELD值不同将患者分为3组：A组〈15，B组15～24和C组≥25，用Kaplan—Meier生存分析方法比较3组患者肝移植术后的生存率差别。结果MELD和CTP评分预测肝移植术后1、3、12个月生存率的c-statistic值分别为0．765和0．793、0．711和0．713、0．681和0．688。两者在同一时间的c-statistic值差异均无统计学意义。MELD评分与CTP评分有相关性（r=0．669，P=0．000）。A组和B组之间生存率差异无统计学意义（P=0．665），但C组生存率明显低于A组和B组，差异有统计学意义（分别为P=0．007和P=0．031）。结论MELD可以作为预测良性终末期肝病肝移植患者术后中、短期生存的指标，MELD≥25患者肝移植预后较差。MELD判断能力与CTP评分无明显差别。Objective To evaluate the model of end-stage liver disease （MELD） in predicting the survival rates of patients with benign end-stage liver disease undergone liver transplantation. Methods The clinical data of 170 patients with benign end-stage liver disease were retrospectively analyzed. The MELD score and Child- Turcotte-Pugh （CTP） score of patients were calculated before transplantation, then the predictive accuracy of MELD and CTP were compared by analyzing area under the receiver operating characteristic （ ROC ） curve （c-statistic value）. According to the MELD scores, all patients were divided into 3 groups： Group A （ 〈 15 ）, Group B （15-24） and Group C （ ≥25 ）. Kaplan -Meier survival analysis was used to compare the survival rates among the 3 groups. Results The c-statistic value for MELD and CTP was 0.765 vs 0. 793, 0.711 vs 0. 713 and 0.681 vs 0.688 respectively at 1, 3, 12 months after transplantation. There was no statistical difference of the c-statistic value between MELD and CTP at the same time point. There was excellent correlation between the MELD and CTP scores （ r = 0.669, P = 0. 000）. The survival rates between Group A and B had no statistical difference （ P = 0.665 ）, and the survival rates in Group C were significantly lower than those in Group A and B, with statistical significance （ P 〈 0.05 ）. Conclusions The MELD score is a relatively useful predictor of shortterm and middle-term survival rates after liver transplantation in patients with benign end-stage liver disease. The postoperative outcome of patients with MELD score of 25 or higher is relatively poor. The predictive accuracy of MELD score is similar to CTP score.

关 键 词：终末期肝病模型 预测 生存率 肝移植 

分 类 号：R686[医药卫生—骨科学]