MELD、MELD-Na、SOFA评分系统对肝衰竭短期预后的价值  

Values of MELD,MELD-Na and SOFA Scores for Prediction of Liver Failure

作　　者：李晓爽[1] 吕洪敏[2] 李凤惠[1] 泽塔多吉[1] 王芳[2] 向慧玲[2] 

机构地区：[1]天津医科大学研究生院,300070 [2]天津市第三中心医院

出　　处：《天津医药》2012年第9期902-904,共3页Tianjin Medical Journal

摘　　要：目的:比较终末期肝病模型(MELD)、MELD-Na模型、序贯器官衰竭估计(SOFA)评分系统对预测肝功能衰竭患者短期预后的价值。方法:选取290例肝衰竭患者,分为存活组(143例)和死亡组(147例),测量并比较2组的总胆红素(TBIL)、血清肌酐(Cr)、凝血酶原时间(PT)、PT的国际标准化比率(INR)、血小板计数(PLT)、MELD、MELD-Na和SOFA分值。应用受试者工作特征(ROC)曲线下面积评价MELD、MELD-Na及SOFA评分对肝衰竭短期预后的预测价值。结果:死亡组的年龄、TBIL、Cr、INR、MELD、MELD-Na及SOFA评分高于存活组,血清Na+水平低于存活组,差异有统计学意义(P<0.01)。MELD、MELD-Na和SOFA评分越高,病死率越高。MELD、MELD-Na及SOFA评分所得最佳临界值分别为25.01、28.14和7.50。SOFA评分的曲线下面积(AUC)优于MELD-Na评分(Z=11.128,P<0.01)和MELD评分(Z=11.004,P<0.01),MELD-Na评分的AUC优于MELD评分(Z=2.865,P<0.01)。结论:MELD、MELD-Na和SOFA评分均能较好地预测肝衰竭患者短期临床预后,SOFA评分系统对肝衰竭预后判断的价值更高。Objective： To investigate the value of model for end-stage liver disease （MELD） score, MELD with incorporation of serum sodium （MELD-Na） score and the sequential organ failure assessment （SOFA） score for evaluation of prognosis of liver failure. Methods： A total of 290 consecutive patients with liver failure were included in the study and divided into two groups （death group and survival group） according to the prognosis. The levels of total bilirubin （TBIL）, serum creatinine （Cr）, prothrombin time （PT）, PT international normalized ratio （INR）, platelet count （PLT）, MELD, MELD- Na and SOFA were calculated respectively and the comparative analysis was performed. Areas under the receiver operating characteristic curve （AUC-ROC） of MELD, MELD-Na and SOFA were used to assess the prognosis in patients with liver failure. Results： The values of age, TBIL, Cr, INR, MELD, MELD-Na and SOFA were significantly higher in death group than those in survival group （P 〈 0.01）. The serum level of Na＋ was significantly lower in death group than that of survival group （P 〈 0.01）. The mortality of liver failure was higher in patients with the increased scores of MELD, MELD-Na and SOFA. The area under curve （AUC） values generated by the ROC curves was higher for SOFA score（AUC=0.805） than that of MELD-Na score （AUC=0.732） and MELD score （AUC=0.714） respectively. The cut-off scores of three systems were 7.50 （SOFA）, 28.14（MELD-Nn） and 25.01（MELD） respectively, which could discriminate higher and lower mortality accurately. Conclusion ：MELD, MELD-Na and SOFA scores have appreciable value to evaluate the prognosis in patients with liver failure. SOFA is more accurate than that of MELD and MELD-Na scores in assessing prognosis of liver failure.

关 键 词：肝功能衰竭 预后 终末期肝病模型 MELD—Na模型 序贯器官衰竭估计 

分 类 号：R657.3[医药卫生—外科学]