终末期肝病模型评分对妊娠合并重型肝炎短期预后的评价作用  

The effect of MELD scoring system for predicting the short-term prognosis of pregnancy complicating fulminant hepatitis

作　　者：邓柳枝[1] 李小毛[1] 陈敦金[2] 余艳红[3] 唐小平[4] 赵少飞[5] 谭华霖 

机构地区：[1]中山大学附属第三医院妇产科,广东广州510630 [2]广州医学院附属第三医院广州市重症孕产妇救治中心,广东广州510150 [3]南方医科大学附属南方医院,广东广州510515 [4]广州市第八人民医院,广东广州510060 [5]广东省妇幼保健院,广东广州510010 [6]广州市番禺区何贤纪念医院,广东广州511400

出　　处：《中国实用妇科与产科杂志》2010年第3期209-212,共4页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：广东省科技计划项目(编号:2005B340201006);广东省中医药局科技基金(编号:1060166)

摘　　要：目的探讨终末期肝病模型(MELD)评分对妊娠合并重型肝炎短期预后的评价作用。方法计算1994年1月至2007年6月中山大学附属第三医院等6家医院66例妊娠合并重型肝炎患者入院时MELD分值,以及其中26例行剖宫产术、5例阴道分娩的晚期妊娠患者分娩前后的MELD分值及其差值(ΔMELD),分析其与预后的关系,并应用c-统计值评价MELD评分对妊娠合并重型肝炎预后的预测价值。结果66例入院时MELD分值,死亡组(37.14±9.86)高于存活组(22.45±7.42),差异有统计学意义(P<0.01)。31例院内分娩患者中,存活组与死亡组分娩前MELD分值分别为19.57±10.64、30.38±5.71,两组比较差异有统计学意义(P<0.01);26例剖宫产患者中,术后存活组MELD分值逐渐下降,而死亡组MELD分值逐渐上升,两组间手术前后MELD分值差异均有统计学意义(P<0.01)。术后3dMELD分值同术前的差值(△MELD)在存活组与死亡组间差异有统计学意义。c-统计值均>0.8。结论MELD评分对妊娠合并重型肝炎的短期预后显示出非常好的预测价值。剖宫产术后3d同术前MELD分值的差值对于评价预后也有着非常好的预测价值。Objective To investigate the value of model of end-stage liver disease （MELD） scoring for predicting the short-term prognosis of pregnancy complicating fulminant hepatitis. Methods MELD scores of 66 patients with pregnancy complicating fulminant hepatitis on admission were calculated, so did the MELD scores and their differences（ΔMELD）of 26 late pregnancy patients underwent cesarean section and 5 late pregnancy patients underwent vaginal delivery before and after operation/delivery. The relationship between MELD scores or ΔMELD and prognosis was analyzed. Concordance （c）-statistic was used to evaluate the predicting ability of MELD scoring system for the prognosis of pregnancy complicating fulminant hepatitis. Results MELD scores of 66 patients on admission of death group were higher than those of survival group（P0.01）; MELD scores of 31 late pregnancy patients delivered in hospital were compared between survival group and death group before operation/delivery, the difference was significant;MELD scores of 26 patients underwent cesarean section were decreased gradually in survival group after operation, while the MELD scores of death group were increased gradually, the difference of MELD scores between these two groups before and after operation was significant. The difference between preoperative MELD scores and MELD scores three days after operation was significant between survival group and death group. c-statistics were all more than 0.8.Conclusions MELD scoring system shows extraordinary predicting value for the short-term prognosis of pregnancy complicating fulminant hepatitis.The difference between preoperative MELD scores and MELD scores three days after operation also shows good predicting value.

关 键 词：终末期肝病模型 妊娠 重型肝炎 

分 类 号：R71[医药卫生—妇产科学]