MELD对慢性病毒性重型肝炎近期预后的预测价值  

Evaluation of MELD Systems as short-term prognostic index for Chronic Severe Hepatitis

作　　者：周大明[1] 徐洪涛[1] 咸建春[1] 韩立斌[1] 耿爱文[1] 沈雷[1] 彭仕芳[2] 

机构地区：[1]南通大学医学院附属江苏省泰州市人民医院感染科,江苏泰州225300 [2]中南大学湘雅医院,湖南长沙410008

出　　处：《中国现代医学杂志》2010年第3期434-437,441,共5页China Journal of Modern Medicine

摘　　要：目的探讨MELD在慢性病毒性重型肝炎近期预后预测中的作用,并与CTP评分系统比较,为临床应用提供参考。方法以2005年1月～2008年12月于该院治疗的慢性重型病毒性肝炎76例患者为研究对象,入院24h内进行MELD和CTP模型评分。常规治疗出院后随访90d,Kaplan-Meier曲线描述生存,评价MELD对病情及预后作用。并以校准度和分辨度来比较MELD和CTP对预后的评价效力。结果随访90天时,失访1例。90d时生存率为78.7%和95%CI为67.6%～89.8%。晚期MELD评分均明显高于早期和中期(F=9.571,P=0.000),慢性重型肝炎分期也与MELD评分呈正相关(rs=0.742,t=6.781,P=0.000),而死亡者MELD评分均明显高于生存者(t=10.170,P=0.000)。两种评分预后的预测模型分别为:logitP=-4.61+0.15MELD和logitP=3.74+0.25CTP。MELD的预测模型与实际死亡拟合良好(χ2=2.145,P=0.854),而CTP的预测模型拟合相对较差(χ2=4.761,P=0.184)。两种评分都具有良好预测分辨度,曲线下面积分别为0.869(P=0.000)和0.855(P=0.000),95%CI分别为0.801～0.937和0.782～0.928。MELD评分取最佳截断值23分时,判断患者死亡的敏感性为81.8%,特异性为82.8%,预测准确性为82.7%;CTP评分取最佳截断值为10分,判断患者为死亡的敏感性为81.8%,特异性为78.1%,预测准确性为78.7%。结论MELD对慢性病毒性重型肝炎的病情及预后有很好的预测价值。和CTP相比,同样具有较好的预测分辨度,但MELD校准度更佳。【Objective】To investigate the value for MELD model predicting short-term prognosis of severe hepatitis,and compared with the CTP scoring system.【Methods】 A retrospective chart review and statistical analysis were done on 76 patients consecutively admitted for chronic severe hepatitis from January 2005 to December 2008 in our hospital.【Results】 90-day survival rate was 78.7%,95% CI 67.6%-89.8%.MELD score of advanced stage were significantly higher than those of early-and medium-stage（F=9.571,P=0.000）,for chronic severe hepatitis with the MELD score was positively correlated（rs=0.742,t=6.781,P=0.000）,and MELD score of those who died were significantly higher than survivors（t=10.170,P=0.000）.Prognosis of the two score of the forecast model：log P=-4.61＋0.15 MELD and log P=3.74＋0.25 CTP.MELD model predictions have a good fit with the actual death（χ^2=2.145,P=0.854）,and the prediction model for CTP relatively poor fit（χ^2=4.761,P=0.184）.Both two models have good resolution forecast,area under the curve were 0.869（P=0.000） and 0.855（P=0.000） respectively,95% CI were 0.801-0.937 and 0.782-0.928.When MELD score cut-off value was 23,the sensitivity of death was 81.8% and specificity of 82.8%,the forecast accuracy of 82.7%;CTP score cut-off value was 10,the death of patient sensitivity was 81.8% and specificity of 78.1%,78.7% for the forecast accuracy.【Conclusions】 MELD have a good predictive value for short-term prognosis of chronic severity viral hepatitis.Compared with CTP,they both have better resolution,but MELD has a better calibration.

关 键 词：慢性乙型肝炎 重型 终末期肝病模型 预后 

分 类 号：R512.62[医药卫生—内科学]