改进的终末期肝病模型对肝移植患者术后早期临床结果的预测价值  

The predictive value of the revised model for end-stage liver disease （MELD） in the clinical earlystage af-ter liver transplantation

作　　者：陈剑尉[1] 谭永法[1] 周杰[1] 阚和平[1] 罗振超[1] 陈立言[1] 

机构地区：[1]南方医科大学附属南方医院肝胆外科,广州510515

出　　处：《中华肝胆外科杂志》2013年第2期108-111,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨改进的终末期肝病模型（model for end-stage liver disease，MELD）对肝移植患者术后早期临床结果的预测价值。方法回顾性分析218例肝移植患者的临床资料。利用受试者工作特征（receiver operating characteristic，ROC）曲线下面积（area under a curve，AUC）评价MELD、ReFitMEI。D及ReFitMELDNa评分预测患者肝移植术后3个月生存率的准确性。将各评分依各自临界值分成两组，分析各组早期并发症发生率与生存率结果。结果MELD、ReFitMELD及ReFitMELDNa评分预测肝移植患者术后3个月的AUC分别为0．737（95％可信区间0．621～0．854）、0．727（95％可信区间0．663～O．785）及0．735（95％可信区间0．671～0．792），各评分间AUC无显著差异。各评分较高者术后3个月内肺部感染、腹腔感染和急性肾功能衰竭发生率及死亡率均显著升高。结论术前ReFitMELD及ReFitMELDNa评分可作为肝移植患者术后早期生存的预测指标，但其预测能力与MEI．D评分无显著差异。三种评分高于各自临界值时并发症发生率较高，预后较差。Objectives To evaluate the predictive value of the revised model for end stage liver disease in the clinical early stage after liver transplantation. Methods The clinical data of 218 patients were retrospectively analyzed. After calculating the MELD score, ReFit MELD score and ReFit MELDNa score before transplantation, we compared the predictive accuracies oi these scoring systems using the area under curve （AUC） of the receiver operating characteristic. The groups were catego- rized with the cut-offs of the MELD, ReFit MELD and ReFit MELDNa, and the early-stage complications and mortality in the different groups were analyzed. Results The AUC for the MELD, ReFit MELD and ReFit MELDNa were 0. 737 （95%CI 0. 621%0. 854）, 0. 727 （95 %ff0CI 0. 663-0. 785） and 0. 735 （95%CI 0. 671%0. 792）, respectively. There was no statistical difference is the AUC among the MELD, ReFit MELD and ReFit MELDNa. Elevated scores in the 3 models predicted higher rates of pulmonary infection, abdominal infection and acute renal dysfunction, as well as a higher mortality. Conclusions The ReFit MELD score and ReFit MELDNa score were relatively useful predictors of short-term survival rates after liver transplantation. The predictive accuracy was similar to the MELD score. Values of the score above the cutoff values indicated higher rates of complication and poorer orognosis.

关 键 词：终末期肝病模型 预测 生存率 肝移植 并发症 

分 类 号：R657[医药卫生—外科学]