移植前终末期肝病模型评分与肝纤维化程度的相关性研究  

A correlation between pretransplantation model for end-stage liver disease score and degree of hepatic fibrosis in explanted livers

作　　者：左怀全[1] 叶念[1] 严律南[2] 曾勇[2] 吴泓[2] 周立新[2] 

机构地区：[1]四川泸州医学院附属医院外科,泸州646000 [2]四川大学华西医院外科

出　　处：《中华消化杂志》2008年第10期694-698,共5页Chinese Journal of Digestion

摘　　要：目的通过将临床终末期肝病模型（MELD）评分及Ishak病理学肝纤维化分级的相关性进行比较，探讨运用MELD评分评估肝移植患者肝纤维化程度的可行性。方法采用计算机辅助图像分析法，定量评估华西医院2006年2至9月58例因终末期肝病接受肝移植手术者病肝标本的纤维化程度，同时运用改良Ishak肝纤维化分级法进行病理学诊断；收集入院当天的临床资料，计算MELD评分，利用Spearman等级相关分析法分析图像法、Ishak分级、MELD评分三者间的相关性，利用直线回归分析MELD评分与肝纤维化程度二者之间有无线性依存关系，按其结果拟定参考标准。结果图像分析法测定58例患者病肝标本的肝纤维化百分比为23．2％～88．4％，平均56．7％；入院当天的MELD评分为11～38分，平均22．85±9．32；Ishak分级0～6级者分别为0、2、7、12、18、12、7例，随着Ishak级数加大，肝纤维化百分比渐增，MELD评分逐步增高，Spearman等级相关分析表明其相关性有统计学意义（P〈0．01），利用直线回归分析MELD评分与肝纤维化程度二者之间也存在线性依存关系。结论图像分析法能较准确地评估肝组织纤维化程度，与MELD评分有良好的相关性，运用MELD评分系统能对肝移植患者肝组织纤维化的严重程度进行评估。Objective To investigate the probability of assessment of hepatic fibrosis for liver transplantation using model for end-stage liver disease（MELD） by comparing the correlation of MELD score with Ishak pathological grading method. Methods Fifty-eight patients who underwent liver transplantation because of end-stage liver disease from February 2006 to September 2006 were performed quantitative hepatic fibrosis evaluation using computer-assisted digital image analysis. Pathological diagnosis according to the Ishak modified score was also performed. MELD scores were calculated using the original formula based on the clinical examination data collected on the admission days. The correlations among the image analysis method, Ishak grading and MELD scoring method were analyzed using the Spearman＇s rank correlation analysis. The linear relationship between the MELD scores and the degree of hepatic fibrosis shown from linear regression analysis was used to define the reference criterion. Results The hepatic fibrosis area ratios of the 58 patients were between 23.2% and 88.4% with average of 56.7% by computer-assisted digital image analysis. The MELD scores on the admission days were between 11 and 38 with average of 22.85±9.32. The semi-quantitative Ishak classification showed that there were 0, 2, 7, 12, 18, 12, and 7 cases in each of the 7 grades respectively, the higher the grade the higher the hepatic fibrosis area ratio and the higher the MELD scores. Spearman rank correlation test indicated that there was significant correlation among these three methods（P 〈 0.01）. Linear regression analysis showed that there was a linear relationship between the MELD scores and the degree of hepatic fibrosis. Conclusions Computer-assisted digital image analysis can evaluate objectively the hepatic fibrosis degree and it is significantly correlated to the MELD system. Hepatic fibrosis degree can be evaluated by MELD scores.

关 键 词：肝纤维化 终末期肝病模型 肝移植 

分 类 号：R686[医药卫生—骨科学]