三种终末期肝病模型预测慢性重型乙型肝炎患者预后  

Three models for end-stage liver disease prognosis in patients with chronic severe hepatitis B

作　　者：吴玲[1] 齐蕾[1] 郜玉峰[2] 苏菲[3] 

机构地区：[1]安徽医科大学附属安庆医院感染病科,安徽安庆246003 [2]安徽医科大学第二附属医院肝病科 [3]安徽医科大学第一附属医院感染病科

出　　处：《中国病毒病杂志》2011年第6期430-433,共4页Chinese Journal of Viral Diseases

基　　金：国家自然科学基金(30700698)

摘　　要：目的评价三种终末期肝病模型(model for end-stage liver disease,MELD)对慢性重型乙型肝炎患者短期预后的预测价值及准确性。方法对193例慢性重型乙型肝炎患者进行回顾性分析,分别应用MELD、MELD-Na(MELD with the incorporation of serum sodium)及MESO(MELD to sodium index)模型对患者进行评分,计算3个月内的病死率,并应用c-统计值评估预测准确性。结果 193例慢性重型乙型肝炎患者3个月死亡率为73.6%(142/193)。三种模型值中位数(范围)在死亡组、生存组分别为30(15～61)、35.0(19.0～84.9)、2.3(1.2～5.2);23(16～34)、24.0(16.0～49.9)、1.6(1.2～2.5),两组间差异有统计学意义(P<0.01)。三者中c-统计值最大是MESO(0.850),最小是MELD(0.830)。结论三种模型均可用于预测慢性重型乙型肝炎患者的短期(3个月)预后,且病死率随三者分值增加而上升,MESO临床价值优于前两者。Objective To investigate the prognostic value of three models for the end-stage liver disease（MELD） of chronic severe hepatitis B.Methods A total of 193 adult patients with chronic severe hepatitis B were reviewed retrospectively.The scores of MELD,MELD with the incorporation of serum sodium（MELD-Na） and MELD to sodium index（MESO） for patients were calculated.The 3-month mortality of patients was measured,and the validity of the models was determined by the means of concordance（c）-statistics.Results One hundred and forty two patients（73.6%）were died within 3 months.The median（95% confidence interval） scores of MELD,MELD-Na and MESO at hospital admission were 30（15-61）,35.0（19.0-84.9） and 2.3（1.2-5.2）among patients died within 3 months,and were 23（16-34）,24.0（16.0-49.9）and 1.6（1.2-2.5）among the survival patients,respectively.The scores of MELD,MELD-Na and MESO were significantly different between the survival and death groups（P〈0.01）.Areas under curve（AUC） were the highest for MESO（0.850）,followed by MELD-Na（0.833） and MELD（0.830）.Conclusions All three models can be used for the prognosis of chronic severe hepatitis B patients.The method of MESO has a better prognostic value as compared to MELD-Na and MESO.The survival chance of patients is negatively associated with the calculated scores of models.

关 键 词：慢性重型乙型肝炎 终末期肝病模型 预后 

分 类 号：R512.62[医药卫生—内科学]