终末期肝病模型评分/血钠比值对肝硬化食管静脉曲张破裂出血硬化治疗预后判断的价值  

Value of end-stage liver disease model score/the value of blood sodium ratio in the prognosis of endoscopic sclerotherapy for the cirrhosis esophageal varices rupture and bleeding

作　　者：陈康部 张金平[2] 李岳桓 

机构地区：[1]梧州市红十字会医院消化内科,广西梧州543002 [2]郑州大学第一附属医院消化科

出　　处：《胃肠病学和肝病学杂志》2016年第9期1018-1021,共4页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的评估终末期肝病模型评分/血钠比值(MESO指数)对肝硬化食管静脉曲张破裂出血(esophageal varices rupture and bleeding,EVB)患者内镜硬化治疗(endoscopic sclerotherapy,EIS)的生存预测价值。方法回顾性分析41例具有完整随访资料、且首次发生EVB并行急诊EIS的肝硬化患者,分别计算每例患者入院当天的血钠比值(blood sodium ratio,MESO)指数、MELD-Na、终末期肝脏病模型(end-stage liver disease model,MELD)和Child-Turcotte-Pugh(CTP)评分值。分析MESO指数与MELD-Na、MELD、CTP评分的相关性。以受试者工作曲线(ROC)及曲线下面积(AUC)评价上述各模型判断行急诊EIS患者预后的准确性。获取各模型判断患者预后死亡风险的最佳临界值。结果随访3个月、12个月,生存患者与死亡患者年龄、性别构成比较差异无统计学意义(P>0.05)。41例患者随访3个月有5例死亡,死亡组MESO指数1.34±0.10,生存组0.49±0.11;随访1年死亡患者12例,生存组MESO指数0.36±0.14,死亡组1.26±0.15,差异具有统计学意义(P<0.05)。MESO指数、MELD、MELD-Na和CTP评分对3个月预后评估的ROC曲线下面积分别为0.917、0.857、0.854和0.786,对1年预后评估的ROC曲线下面积分别为0.885、0.835、0.829和0.746,但差异无统计学意义(P>0.05)。MESO指数的最佳临界值有较高的死亡风险判断价值。判断患者预后时,ROC曲线下面积值>0.800的模型,3个月为MESO(0.917)、MELD(0.857)、MELD-Na(0.854);12个月为MESO(0.885)、MELD(0.835)、MELD-Na(0.829)。结论 MESO指数越高,死亡风险越大,MESO指数对肝硬化EVB患者行急诊EIS的3个月和1年预后的判断有较高的准确性。Objective To assess the survival predictive value of the end-stage liver disease model score/sodium ratio （MESO index） in the endoscopic selerotherapy （EIS） for cirrhosis esophageal varices rupture and bleeding （EVB）. Methods Fortyone patients who had a complete follow-up data, first occurred liver cirrhosis EVB and received emer- gency EIS, were analyzed retrospectively. The blood sodium ratio （MESO index） , MELD-Na, end-stage liver disease model （MELD） and CTP rating value of each case were calculated severally on the day of admission. The correlation of MESO index with MELD-Na, MELD, Child-Tureotte-Pugh （CTP） score was analyzed. The accuracy of above models in the prognosis of determining emergency EIS patients was evaluated by receiver operating curve （tlOC） and area under the curve （AUC）. The best critical value was obtained that each model determined the patients＇ prognosis death risk. Results Within the follow-up 3 and 12 months, there was no significant difference in age and gender between survival and death patients （P 〉0.05）. Within follow-up 3 months, there were 5 cases death among 41 patients, MESO index was l. 34 ±0.10 in death group and 0.49 ± 0. 11 in survival group; within the follow-up one year, there were 12 patients death, MESO index was 1.26 ± 0, 15 in death group and 0.36 ± 0.14 in survival group, the differences of both had statistical significance （P 〈 0.05）. The ROC curve area which was evaluated within 3 months prognosis under the influence of MESO index, MELD, MELD-Na and CTP score were 0.917, 0. 857, 0.854 and 0.786, respectively. In terms of one-year prognosis, the ROC curve area were 0. 885, 0. 835, 0. 829 and 0. 746, respectively. But the difference had no statistical significance （P 〉 0.05）. The optimal critical value of MESO index had a higher death risk judgment value. When judged the prognosis of patients, the MESO, MELD and MELD-Na of models whose ROC curve area value was more than 0. 800 within 3 months were 0. 917, 0. 857

关 键 词：终末期肝病模型 肝硬化 食管静脉曲张 预后 

分 类 号：R575.2[医药卫生—消化系统]