终末期肝病模型评分和血清钠浓度及腹水情况评估良性终末期肝病肝移植的预后  

Evaluation of postoperative short-term survival rate after liver transplantation for benign end-stage hepatopathy by model for end-stage liver disease score and serum sodium concentration and ascites condition

作　　者：蔡志仕[1] 江艺[1] 吕立志[1] 张小进[1] 蔡秋程[1] 

机构地区：[1]福建医科大学福州总医院临床医学院肝胆外科,福州350025

出　　处：《中华消化外科杂志》2009年第1期36-38,共3页Chinese Journal of Digestive Surgery

基　　金：基金项目：全军“十一五”杰出人才课题（06J007）

摘　　要：目的探讨终末期肝病模型（MELD）评分和血清钠浓度及腹水情况埘良性终末期肝病患者肝移植术后生存情况的评估作用。方法回顾性分析1999年1月至2007年2月福州总医院临床医学院98例行肝移植的良性终末期肝病患者的临床资料。分析患者术前在相同MELD评分下血清钠浓度、腹水情况与手术预后的关系。采用Kaplan-Meier法绘制生存曲线、X^2检验比较分组后患者的1年生存率、Fisher精确概率法比较相同MELD评分下患者术后3个月病死率。结果在MELD评分为15～25分和〉25分的情况下，血清钠浓度≥130mmol／L的患者术后3个月病死率分别为5％和15％，低于血清钠浓度〈130mmoL／L患者的33％和55％，其1年生存率比较差异有统计学意义（X^2=12．88，P〈0．05）。MELD评分在15～25分和〉25分的情况下，无腹水的患者术后3个月病死率分别为5％和8％，低于有腹水患者的35％和57％，其1年生存率比较差异有统计学意义（X^2=15．26，P〈0．05）。结论将血清钠浓度、腹水情况与MELD评分结合，能更准确的评估良性终末期肝病患者肝移植术后短期生存情况。Objective To investigate the efficiency of model for end-stage liver disease （MELD） score. serum sodium concentration and ascites condition in the evaluation of short-term survival rate of patients with benign end-stage hepatopathy after liver transplantation. Methods The clinical data of 98 patients with benign end-stage hepatopathy who had undergone liver transplantation in Fuzhou General Hospital from January 1999 to February 2007 were retrospectively analyzed. The relationship between serum sodium concentration, ascites condition and the prognosis of patients with the same MELD score was analyzed. Kaplan-Meier survival curve was drawn. The 1-year survival rate of the patients was analyzed by chi-square test. The mortality of patients with the same MELD score at the end of the third month after operation was analyzed by Fisher＇s exact test. Results MELD score of all patients was 15-25 or 〉 25. The postoperative 3-month mortality rates of patients with serum sodium concentration ≥130 mmol/L were 5% and 15% , which were significantly lower than 33% and 55% of those with serum sodium concentration 〈 130 mmol/L. The difference upon 1-year survival rates between them had statistical significance （ X2 = 12.88, P 〈 0.05 ）. The postoperative 3-month mortality rates of patients without ascites were 5% and 8% , which were lower than 35% and 57% of those with ascites, and the difference upon 1-year survival rates between them had statistical significance （X^2 = 15.26, P 〈 0.05）. Conclusions It is more accurate to evaluate the short-term survival rate after liver transplantation for benign end-stage hepatopathy by combining the MELD score with serum sodium concentration and ascites condition.

关 键 词：肝移植 预后 血清钠浓度 腹水 终末期肝病模型评分 

分 类 号：R657.3[医药卫生—外科学] R720.597[医药卫生—临床医学]